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Natile M, Ancora G, D'Andrea V, Pittiruti M, Barone G. A narrative review on tip navigation and tip location of central venous access devices in the neonate: Intracavitary ECG or real time ultrasound? J Vasc Access 2024:11297298241259247. [PMID: 39090995 DOI: 10.1177/11297298241259247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
The proper location of the tip of a central venous access device plays a crucial role in minimizing the risks potentially associated with its use. Recent guidelines strongly recommend preferring real-time, intra-procedural methods of tip location since they are more accurate, more reliable and more cost-effective than post-procedural methods. Intracavitary electrocardiography and real time ultrasound can both be applied in the neonatal setting, but they offer different advantages or disadvantages depending on the type of central venous access device. Reviewing the evidence currently available about the use of these two methods in neonates, in terms of applicability, feasibility and accuracy, it can be concluded that (a) real time ultrasound is the only acceptable methodology for tip navigation for any central venous access device in neonates, (b) intracavitary electrocardiography is the preferred method of tip location for central catheters inserted by ultrasound-guided cannulation of the internal jugular vein or the brachiocephalic vein, and (c) real time ultrasound is the preferred method of tip location for umbilical venous catheters, epicutaneo-cava catheters, and central catheters inserted by ultrasound-guided cannulation of the common femoral vein.
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Affiliation(s)
- Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
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Pittiruti M, Salerno G, Mancino A, Carlini D, Celentano D, Annetta MG, Conti G. Ultrasound versus intracavitary electrocardiography for intraprocedural tip location during central venous catheterization in infants and children: A prospective clinical study. J Vasc Access 2024; 25:774-778. [PMID: 36267035 DOI: 10.1177/11297298221132415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both intracavitary electrocardiography (IC-ECG) and ultrasound (US) have been proven to be safe and accurate for intraprocedural tip location during central venous catheterization, and both are known to be easily applicable and feasible in pediatric patients. Though, no prospective clinical study has directly compared the two methods as regards their applicability, feasibility, and procedural time. METHODS This study prospectively enrolled all children requiring a central venous access device in non-emergency situations, during a period of 1 year. All devices were inserted according to a well-defined insertion bundle including both IC-ECG and US-based tip location. The primary endpoint of the study was to compare the two methods in terms of applicability, feasibility and time required. RESULTS This study included 100 consecutive central venous catheterizations in children of age ranging from 1 month to 18 years. The applicability of IC-ECG based tip location was 98% and its feasibility 100%; the time required for IC-ECG was 1.9 ± 2 min. The applicability of US-based tip location was 96% and its feasibility was 100%; the maneuver required 2.2 ± 3 min. CONCLUSIONS US is an appropriate alternative method for intraprocedural tip location in children. The combined use of US and IC-ECG (both maneuvers being accurate, inexpensive, cost-effective, non-invasive, and equally fast to perform) should be recommended for tip location in pediatric patients, and it will avoid completely the use of fluoroscopy or of post-procedural x-ray.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Gilda Salerno
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Debora Carlini
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Davide Celentano
- Department of Oncology, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
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Zhang S, Zhu Y, Du Y, Yin X. The positioning of the catheter tip with an intracavitary electrocardiogram in epicutaneo-caval catheter placement via lower limbs in newborns: A retrospective study. J Vasc Access 2024; 25:119-124. [PMID: 35634963 DOI: 10.1177/11297298221100174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Few studies have been conducted on whether catheterisation via the lower limb pathway is suitable for intracavitary electrocardiogram (ECG) technology. This study explored the positioning of the epicutaneo-caval catheter (ECC) tip with intracavitary ECG via the lower limbs in newborns to determine its optimal placement and to improve the success rate of ECC placement using this method. METHODS Twenty-eight cases were selected for the observation group. The tip location with intracavitary ECG method was used to observe the changes in specific atrial depolarisation (P-wave) during the catheterisation process to determine whether the catheter tip was in the correct position. For comparative observation, chest X-rays and abdominal radiographs were taken within 24 h to determine sensitivity and specificity. The control group included 28 cases where the ECCs were inserted via the lower limbs, and chest X-rays and abdominal radiographs were taken within 24 h after the line was placed to confirm the correct positioning. RESULTS The success rate of the observation group was 91.30% (there were two cases of primary malposition), and the success rate of the control group was 78.57% (there were six cases of primary malposition). The success rate of the observation group was higher compared with the control group. CONCLUSION The tip location with intracavitary ECG method improved the success rate of ECC placement via the lower limbs in neonates. This method can effectively prevent the occurrence of lower limb primary catheter malposition and has significant clinical application value.
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Affiliation(s)
- Sha Zhang
- Department of Paediatrics, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Yuxin Zhu
- Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Yuqiong Du
- Department of Paediatrics, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Xinxin Yin
- Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang, China
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Pittiruti M, Celentano D, Barone G, D'Andrea V, Annetta MG, Conti G. A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases. J Vasc Access 2023; 24:1477-1488. [PMID: 35533085 DOI: 10.1177/11297298221074472] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. METHODS The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. RESULTS All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. CONCLUSION The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, University Hospital "A. Gemelli," Rome, Italy
| | - Davide Celentano
- Pediatric Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, "Infermi" Hospital, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
| | | | - Giorgio Conti
- Pediatric Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
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D'Andrea V, Pezza L, Prontera G, Ancora G, Pittiruti M, Vento G, Barone G. The intracavitary ECG method for tip location of ultrasound-guided centrally inserted central catheter in neonates. J Vasc Access 2023; 24:1134-1139. [PMID: 35081816 DOI: 10.1177/11297298211068302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The correct position of the tip of a central venous access device is important in all patients, and especially in neonates. The traditional method of tip location (approximated intra-procedural length estimation + post procedural chest X-ray) is currently considered inaccurate and not cost-effective by most recent guidelines, which recommend the adoption of tip location by intracavitary electrocardiography (IC-ECG) whenever possible. METHODS This study prospectively investigated the applicability, the feasibility, the accuracy, and the safety IC-ECG for tip location in neonates requiring insertion of ultrasound-guided centrally inserted central venous catheters (CICCs) with caliber 3Fr or more. All catheter tip locations were verified using simultaneously both IC-ECG and ultrasound-based tip location, using the Neo-ECHOTIP protocol. RESULTS A total of 105 neonates were enrolled. The applicability of IC-ECG was 100% since a P wave was evident on the surface ECG of all neonates recruited for the study. The feasibility was also 100% since an increase of the P-wave was detected in all cases. The accuracy was also 100%, since a perfect match between IC-ECG based tip location and ultrasound-based tip location was found. There were no adverse events directly or indirectly related to the IC-ECG technique; no arrhythmias occurred. CONCLUSIONS When applied to ultrasound guided CICCs, tip location by IC-ECG is applicable and feasible in neonates, and it is safe and accurate.
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucilla Pezza
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
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Uzumcugil F. Ultrasound-guided percutaneous right brachiocephalic vein cannulation in a 5-year-old patient with bilaterally occluded internal jugular veins due to previous access by venous cut-down: A case report. J Vasc Access 2021; 23:819-821. [PMID: 33892605 DOI: 10.1177/11297298211011883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The open surgical venous cut-down technique is widely performed in cases of long-term treatment including administration of chemotherapy, parenteral nutrition, or replacement therapies. However, it has been recommended to avoid this technique considering the resultant unpredictable alterations in the veins draining the relevant site, especially in patients who may need central venous cannulation (CVC) during disease progression. We aimed to report on CVC in a 5-year-old child who had previously undergone bilateral internal jugular venous access by the open venous cut-down technique, in order to highlight the importance of performing the Rapid Central Vein Assessment protocol prior to any intervention and considering to abandon the use of the open surgical venous cut-down technique by gaining experience with ultrasound-guided percutaneous techniques.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
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Barone G, Pittiruti M, Biasucci DG, Elisei D, Iacobone E, La Greca A, Zito Marinosci G, D'Andrea V. Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates. J Vasc Access 2021; 23:679-688. [PMID: 33818191 DOI: 10.1177/11297298211007703] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi di Rimini, AUSL della Romagna, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Daniele G Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Geremia Zito Marinosci
- UOC di Rianimazione e Neuroanestesia, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Neaples, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Park SJ, Chung HH, Lee SH, Kim JE, Kim C, Lee SM. New formulas to predict the length of a peripherally inserted central catheter based on anteroposterior chest radiographs. J Vasc Access 2021; 23:550-557. [PMID: 33752491 DOI: 10.1177/11297298211001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop formulas that predict the optimal length of a peripherally inserted central catheter (PICC) from variables measured on anteroposterior (AP) chest radiography (CXR). MATERIALS AND METHODS A total of 134 patients who underwent PICC insertion at the angiography suites were included. Clinical information such as patient height, weight, sex, age, cubital crease to inferior carina border length (CCL), and approach side were recorded. The following variables via measurement on AP-CXR were also collected: (1) distance from the T1 to T12 vertebra (DTV), (2) maximal horizontal thoracic diameter (MHTD), and (3) clavicle length (CL). RESULTS Significant correlations between CCL and the following variables were identified in linear regression analyses: approach side, height, weight, sex, DTV, MHTD, and CL. Multiple regression results motivated the following two formulas: (1) with height data, estimated CCL (cm) = 12.429 + 0.113 × Height + 0.377 × MHTD (if left side, add 2.933 cm, if female, subtract 0.723 cm); (2) without height data, estimated CCL = 19.409 + 0.424 × MHTD + 0.287 × CL + 0.203 × DTV (if left side, add 3.063 cm, if female, subtract 0.997 cm). Estimated final PICC length can be calculated as (Estimated CCL, cm) + 4.0 (distance from inferior carina border to about 2.0 vertebra body unit, cm) - (distance from set cubital crease to designated puncture point, cm). CONCLUSION This study suggests new formulas to predict the appropriate PICC length for bedside insertion using previous AP-CXRs. With this formula, ideal positioning of the catheter's tip can be achieved in the clinical practice, avoiding or minimalizing the exposed catheter out of skin. These formulas may be helpful for patients who cannot undergo intra-hospital transport due to hemodynamic instability or who are concerned about isolation precautions due to any infectious-related contamination.
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Affiliation(s)
- Sung-Joon Park
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
| | - Jeong-Eun Kim
- Department of Radiology, Ajou University Hospital, Suwon-si, Gyeonggi-do, South Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, South Korea
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Spagnuolo F, Vacchiano T. Ultrasound-guided cannulation of the brachiocephalic vein in newborns: A novel approach with a supraclavicular view for tip navigation and tip location. J Vasc Access 2021; 23:515-523. [PMID: 33726580 DOI: 10.1177/11297298211001159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Central vascular catheters (CVCs) are frequently used in newborns in NICU. Ultrasound (US) guided supraclavicular venipuncture of the brachiocephalic vein (BCV) is usually performed with a 12 MHz linear probe and then a catheter tip location is verified with an 8 MHz micro-convex probe or intracavitary ECG (IC-ECG). We explored the feasibility of an US guided puncture using a 7 MHz sector probe, positioned on the clavicular sternal joint. We also explored the opportunity of performing it with a probe tilting tip navigation and tip location. DESIGN This is a monocentric retrospective observational study made in the neonatal intensive care unit L. Vanvitelli University Hospital of Naples, Italy. PATIENTS Forty newborns in NICU scheduled for an ultrasound guided CVC. INTERVENTIONS US guided brachiocephalic vein catheterization. We used A long axis in plane supraclavicular approach to the BCV for real time puncture, for tip navigation and tip location, using a 7 MHz sector transducer. We executed an ultrasound pre-scan of the Y-shape (right and left BCV, superior vena cava (SVC)) and of the right pulmonary artery (RPA), and then we performed a guided sterile puncture on middle third of supraclavicular fossa next to clavicular sternal joint with a 7 MHz. We used the same probe for tip navigation by this supraclavicular short axis of ascending aorta view. Tip location was confirmed with the ultrasound and IC-ECG. RESULTS In all infants the ultrasound tip navigation and tip location were successful and were confirmed by IC-ECG. No misplacement, arterial puncture or pneumothorax occurred. CONCLUSIONS The supraclavicular view performed with a 7 MHz sector probe has proved to be completely safe and to be a method with 100% feasibility.
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Affiliation(s)
- Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, University of Study "L. Vanvitelli" Naples, Napoli, Italy
| | - Teresa Vacchiano
- Neonatal Intensive Care Unit, University of Study "L. Vanvitelli" Naples, Napoli, Italy
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Gu L, Xu L, Meng A, Shi R, Jiang D, Liu C, Mao J. Guidewire‐guided electrocardiogram for positioning the catheter tip of upper arm port in breast cancer patients. PRECISION MEDICAL SCIENCES 2021. [DOI: 10.1002/prm2.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lili Gu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Liyong Xu
- Department of General Surgery Nanjing Agriculture University Hospital Nanjing China
| | - Aifeng Meng
- Department of Nursing Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Ruchun Shi
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Dingbiao Jiang
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Chunli Liu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Jing Mao
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Pittiruti M, Pelagatti F, Pinelli F. Intracavitary electrocardiography for tip location during central venous catheterization: A narrative review of 70 years of clinical studies. J Vasc Access 2020; 22:778-785. [PMID: 32578489 DOI: 10.1177/1129729820929835] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracavitary electrocardiography is an accurate and non-invasive method for central venous access tip location. Using the catheter as a traveling intracavitary electrode, intracavitary electrocardiography is based on the increase in the detected amplitude of the P wave while approaching the cavoatrial junction. Despite having been adopted diffusely in clinical practice only in the last years, this method is not novel. In fact, it has first been described in the late 40s, during electrophysiological studies. After a long period of quiescence, it is in the last two decades of the XX century that intracavitary electrocardiography became popular as an effective mean of central venous catheters tip location. But the golden age of this technique began with the new millennium, as documented by high-quality studies in this period. In fact, in those years, intracavitary electrocardiography has been studied broadly, and important achievements in terms of comprehension of the technique, accuracy, and feasibility of the method in different populations and conditions (i.e. pediatrics, renal patients, atrial fibrillation) have been gained. In this review, we describe the technique, its history, and its current perspectives.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
| | - Filippo Pelagatti
- School of Human Health Science, University of Florence, Florence, Italy
| | - Fulvio Pinelli
- Anesthesia and Intensive Care, University Hospital Careggi, Florence, Italy
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Uzumcugil F, Yilbas AA, Akca B. Ultrasound-guided anatomical evaluation and percutaneous cannulation of the right internal jugular vein in infants <4000 g. J Vasc Access 2019; 21:92-97. [PMID: 31081445 DOI: 10.1177/1129729819845620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The commonly preferred right internal jugular vein was investigated in terms of its dimensions, the relationship between its dimensions and anthropometric measures, and the outcomes of its cannulation in infants. Data regarding its position with respect to the carotid artery indicated anatomical variation. AIM The aim of this study was to share our observations pertaining to the anatomy and position of the right internal jugular vein with respect to carotid artery using ultrasound and our experience with ultrasound-guided right internal jugular vein access in neonates and small infants. MATERIALS AND METHODS A total of 25 neonates and small infants (<4000 g) undergoing ultrasound-guided central venous cannulation via right internal jugular vein within a 6-month period were included. Ultrasound-guided anatomical evaluation of the vein was used to obtain the transverse and anteroposterior diameters, the depth from skin and the position with respect to the carotid artery. Real-time ultrasound-guided central cannulation success rates and complication rates were also obtained. The patients were divided into two groups with respect to their weight in order to compare both the position and the dimensions of right internal jugular vein and cannulation performance in infants weighing <2500 g and ⩾2500 g. RESULTS The position was lateral to the carotid artery in 84% of all infants and similar in both groups. The first-attempt success rates of cannulation were similar (70% vs 73.3%) in both groups, with an overall success rate of 88%. CONCLUSION Right internal jugular vein revealed a varying position with respect to carotid artery with a higher rate of lateral position. The presence of such anatomical variation requires ultrasonographic evaluation prior to interventions and real-time guidance during interventions involving right internal jugular vein.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysun Ankay Yilbas
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Basak Akca
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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