Pediatric Anaesthesia Unit, Department of Anesthesia, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
Minerva Anestesiol. 2013 Apr;79(4):379-84. Epub 2013 Jan 31.
In children the position of the tip of central venous catheters (CVC) is most often examined by chest radiography. Endovascular electrocardiography (ECG), using the CVC as an electrode, permits the correct placement of a CVC without the need for a chest X-ray. The use of a commercialised endovascular ECG-system (Alphacard®) for CVC-placement was evaluated in pediatric patients.
ECG-guidance was prospectively applied in 50 children (0-17 years, stratified into 5 age related subgroups). Positioning of the CVC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided CVC-placement in one single attempt, duration until confirmation by ECG and X-ray, and body weight-related depth of CVC-insertion were assessed.
In 44 patients ECG-guidance resulted in a correct placement of the CVC-tip. Duration (median and [IQR] in sec.) to confirmation of correct placement was shorter with the ECG method (78[49-136]) than with X-ray (720[249-1095]) (P<0.0001). In five patients the ECG method failed because the CVC chosen was too short or the anesthetist did not trust the ECG-method. In one patient an unknown anatomical anomaly was present. Depth of insertion of the CVC was positively correlated with body weight (r2 0.68, P<0.0001). Stratification for age had no impact on duration until confirmation of CVC-position. No complications occurred during CVC-placement.
ECG guidance of CVC-placement in children is a reliable technique, preventing children and health care providers from unnecessary X-ray exposure. Depending on local infrastructure and protocols it can furthermore shorten the procedure of CVC placement.
在儿童中，中心静脉导管（CVC）尖端的位置通常通过胸部 X 射线检查。使用 CVC 作为电极的血管内心电图（ECG）可在无需胸部 X 射线的情况下正确放置 CVC。本研究旨在评估商业化的血管内 ECG 系统（Alphacard®）在儿科患者中用于 CVC 放置的效果。
前瞻性地将 ECG 引导应用于 50 名患儿（0-17 岁，分为 5 个年龄相关亚组）。在 ECG 引导下进行 CVC 定位，然后通过胸部 X 射线评估。评估单次尝试中正确 ECG 引导的 CVC 放置的频率、ECG 和 X 射线确认的时间以及与体重相关的 CVC 插入深度。
在 44 名患者中，ECG 引导导致 CVC 尖端的正确放置。使用 ECG 方法确认正确放置的时间（中位数和[IQR]，秒）短于 X 射线（720[249-1095]）（P<0.0001）。在 5 名患者中，由于选择的 CVC 太短或麻醉师不信任 ECG 方法，ECG 方法失败。在 1 名患者中，存在未知的解剖异常。CVC 插入深度与体重呈正相关（r2 0.68，P<0.0001）。年龄分层对 CVC 位置确认的时间没有影响。在 CVC 放置过程中未发生任何并发症。
ECG 引导 CVC 放置在儿童中是一种可靠的技术，可以防止儿童和医疗保健提供者受到不必要的 X 射线照射。根据当地的基础设施和方案，它还可以缩短 CVC 放置的过程。
