Determination of the optimal length of insertion of central venous catheters in pediatric patients by endovascular ECG

Background. 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. Methods. 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. Results. 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. Conclusion. 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.

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