Pelagatti Cecilia, Villa Gianluca, Casini Andrea, Chelazzi Cosimo, De Gaudio Angelo Raffaele
Department of Critical Care, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
J Vasc Access. 2011 Oct-Dec;12(4):348-53. doi: 10.5301/JVA.2011.8380.
Appropriate tip position of totally implantable central venous catheters is essential in order to prevent catheter-related complications, in particular thrombosis. Endovascular electrocardiography is an economic and safe method to guide placement of catheters into the central veins. Although widely utilized, there is still lack of conclusive evidence about its efficacy. The aim of the study was to assess the efficacy and safety of endovascular electrocardiographic guided placement compared to the anthropometric method.
Endovascular ECG was employed to guide electrocardiographic placement of a central venous catheter in a cohort of oncologic patients. The rate of correct placement and the incidence of catheter-related thrombosis were considered. Patients in which central venous catheters were inserted with the anthropometric technique were considered as control group.
The rate of correct placement was 91% and 50% for ECG-guided and anthropometric catheters (p<0.0001) respectively. None of the patients suffered from early insertion-related complications. The rate of catheter-related vascular thrombosis was lower for ECG-guided catheters (3.6% vs. 9.6%, n.s.), in particular for left-inserted catheters (0% vs. 33.3%, p=0.02).
Endovascular electrocardiography was more effective than the anthropometric technique in placement of implantable central venous catheters and was associated with a lower incidence of catheter-related thrombosis, in particular for those inserted from the left-side.
为预防与导管相关的并发症，尤其是血栓形成，全植入式中心静脉导管的合适尖端位置至关重要。血管内心电图检查是一种经济且安全的引导导管置入中心静脉的方法。尽管已被广泛应用，但关于其疗效仍缺乏确凿证据。本研究的目的是评估与人体测量法相比，血管内心电图引导置入的疗效和安全性。
在一组肿瘤患者中采用血管内心电图引导中心静脉导管的心电图置入法。考虑正确置入率和导管相关血栓形成的发生率。将采用人体测量技术插入中心静脉导管的患者作为对照组。
心电图引导导管和人体测量导管的正确置入率分别为91%和50%（p<0.0001）。没有患者出现早期与置入相关的并发症。心电图引导导管的导管相关血管血栓形成率较低（3.6%对9.6%，无统计学意义），特别是左侧置入的导管（0%对33.3%，p=0.02）。
在植入式中心静脉导管的置入方面，血管内心电图比人体测量技术更有效，且与导管相关血栓形成的发生率较低相关，特别是对于从左侧插入的导管。
