Dionisio P, Valenti M, Cornella C, Caramello E, Bergia R, Cravero R, Stramignoni E, Pellerey M, Berto I M, Bajardi P
Department of Nephrology, Ospedale degli Infermi Biella, Italy.
Nephrol Dial Transplant. 1995;10(6):874-6.
Mismanagement in the placement of central venous catheter (CVC) may occur in up to 20% of cases. The catheter can be inadvertently placed in the contralateral brachiocephalic vein, the ipsi or contralateral internal jugular vein, and usually a thoracic radiograph is necessary to evaluate its location. We propose a technique first described by Serafini et al. to establish the position of a CVC by endocavitary electrocardiography (EC-ECG) and its employment in a large number of uraemic patients requiring haemodialysis. This technique uses the tip of the CVC as reference lead in a standard electrocardiograph. The best employment of this technique has been obtained by echotomographic visualization of the internal jugular vein executed just before transcutaneous puncture of the vessel. For 13 months we have successfully applied this technique in CVC placement in 81 patients requiring haemodialysis. In our opinion this method is a safe and simple technique that avoids the need for thoracic radiographs and time lost waiting for radiographs that prolong the start of the haemodialysis session. According to our experience, we confirm that the EC-ECG technique provides a method for ensuring compliance with Food and Drug Administration guidelines regarding catheter tip location in uraemic patients.
中心静脉导管（CVC）放置不当的情况在高达20%的病例中可能发生。导管可能会无意中置入对侧头臂静脉、同侧或对侧颈内静脉，通常需要进行胸部X光检查以评估其位置。我们提出一种首先由Serafini等人描述的技术，通过腔内心电图（EC-ECG）来确定CVC的位置，并将其应用于大量需要血液透析的尿毒症患者。该技术将CVC的尖端用作标准心电图仪中的参考导联。通过在经皮穿刺血管前对颈内静脉进行超声断层显像，可实现该技术的最佳应用。在13个月的时间里，我们已成功地将此技术应用于81例需要血液透析患者的CVC放置。我们认为，这种方法是一种安全且简单的技术，避免了对胸部X光检查的需求以及等待X光片而延误血液透析开始时间所造成的时间损失。根据我们的经验，我们确认EC-ECG技术提供了一种确保符合美国食品药品监督管理局关于尿毒症患者导管尖端位置指南的方法。
