ECC Guidance for CVC Placement

ECC Guidance for CVC Placement To the Editor: I would like to congratulate Andropoulus et al. (1) for their recommendations for central venous catheter (CVC)-placement in pediatric patients. Nevertheless, I would like to stress a different approach using ECG-guidance for verification of the correct position of the catheter in addition to calculating the length by the formula given by Andropoulus. Corsten et al. stated in 1994 based on a study of 89 patients that when a p-atriale is seen, uncomplicated insertions do not require radiologic control of the catheter tip position (2) and Salmela reported only a failure rate to obtain a good ECG-signal using a water column based system of 8.2% in 350 patients (3). In my personal experience with pediatric patients, the use of intraatrial ECG either with a water column (Alphacard®, Braun, Melsungen, Germany) or a special guide wire (Certodyn®, Braun, Melsungen, Germany) connected to the ECG-monitor confirms the right position of the catheter tip in most cases even in peds with a high heart rate. If the catheter position is confirmed by ECG, a chest radiograph might not be necessary in most cases with the exception of subclavian punctures. Sebastian Schulz-Stübner, MD