ECG-Controlled Central Line Insertion

Using the insertion guidewire as an intra-atrial electrode greatly increased the likelihood of correct line placement, but is it worth all the fuss?

Placement of a central venous catheter (CVC) in the right atrium or ventricle can increase complications and provide misleading measurements. Electrocardiogram guidance is widely used in Europe to aid CVC placement but not in North America. Evidence for its effectiveness is not conclusive. In a randomized, controlled study, researchers evaluated ECG-guided CVC insertion in 290 patients without atrial fibrillation or pacemakers who were undergoing elective general anesthesia that required CVC placement.

All participating anesthesiologists underwent training that covered guidelines for depth of CVC insertion. CVCs were inserted by Seldinger technique after general anesthesia was induced. In the group randomized to ECG guidance, the catheter wa…

Reviewing Author

Ron M. Walls, MD, FRCPC, FACEP, FAAEM