Calabria Maria, Zamboli Pasquale, D'Amelio Alessandro, Granata Antonio, Di Lullo Luca, Floccari Fulvio, Logias Franco, Fiorini Fulvio
Cattedra di Nefrologia, Seconda Universita' degli Studi di Napoli, Napoli, Italy.
G Ital Nefrol. 2012 Jan-Feb;29(1):49-57.
Central venous catheters (CVC) are widely used in clinical practice for the administration of chemotherapy, parental nutrition, hemodynamic monitoring, and hemodialysis. International guidelines have defined the right internal jugular vein as the preferred site of CVC insertion and underline that accurate positioning of the catheter tip is essential to maximize the blood flow and reduce long-term complications. Endocavitary electrocardiography (EC-ECG) improves the accuracy of catheter tip positioning without increasing the placement time by the recognition of typical P wave patterns during catheter insertion:the normally shaped P wave identifies the mid to upper superior vena cava, the widest P wave may be used to place the CVC tip at the superior vena cava-right atrium junction, and biphasic P waves identify the location of the right atrium. Because of its simplicity and safety, EC-ECG should always be considered during CVC placement, especially if other means of verifying correct CVC insertion are not available.
中心静脉导管（CVC）在临床实践中广泛用于化疗给药、肠外营养、血流动力学监测和血液透析。国际指南已将右侧颈内静脉定义为CVC插入的首选部位，并强调导管尖端的准确定位对于最大化血流和减少长期并发症至关重要。腔内心电图（EC-ECG）通过在导管插入过程中识别典型的P波形态来提高导管尖端定位的准确性，而不会增加放置时间：正常形状的P波可确定上腔静脉中上部，最宽的P波可用于将CVC尖端放置在上腔静脉与右心房交界处，双相P波可确定右心房的位置。由于其简单性和安全性，在放置CVC时应始终考虑使用EC-ECG，尤其是在没有其他验证CVC正确插入的方法时。
