Accuracy of electrocardiography guidance for depth of insertion of central venous catheters in children: A prospective observational study

Context: Central venous catheters (CVCs) have become integral in the pediatric intensive care setting as well as in the operating room (OR). In the OR, these lines are usually used without prior confirmation of correct position, and a chest radiograph is performed postoperatively, several hours later. Hence, it is desirable to confirm the correct CVC position immediately after placement. Aim: This observational study was designed to evaluate the accuracy of electrocardiography (ECG) guidance on correct CVC positioning in pediatric population. Settings and Design: This was a prospective observational study. Subjects and Methods: Patients till 12 years of age were included in the study. Ultrasound was used to guide initial cannulation of the vessel. Certodyn® universal adaptor was connected to the guidewire via a sterile alligator clip. The CVC along with the guidewire was advanced till it lies in the right atrium which was seen by an increase in the amplitude of P-wave on the intracardiac ECG. The CVC was then withdrawn slowly until the P-wave morphology returned to normal or preprocedural configuration. Statistical Analysis Used: Data were expressed as percentage. Results: Out of the 68 patients, the percentage of patients having appropriate position of CVC tip was 95.5% (65 patients). Out of the three patients with incorrect tip position, in two patients, the tip was distal to the appropriate position and in one case, the ECG changes could not be appreciated. Conclusions: ECG-guided CVC placement has high accuracy of correct positioning in infants and children.