CVP catheter confirmation question - page 2

by aquaphone | 5,470 Views | 18 Comments

We all know the gold standard for confirmation of a CVP catheter is a chest x-ray. However, if that is not immediately available, has anyone heard of: Confirmation via ECG? or Confirmation via doppler while injecting... Read More


  1. 0
    That's interesting about the PICC line placement. I've seen plenty of central lines placed, but I've never personally seen a PICC line placed. In my unit (MICU/SICU) the patients would always go off the unit for PICC placement.

    So I'm amazed at what you're saying; you really do use ECG as the only confirmation for PICC line? Have you actually been able to observe the procedure? How does it work?

    Quote from MunoRN
    While EKG changes are useful when placing a CVP or PA line, they'll never replace a CXR since the primary reason for a CXR following an IJ or SC line placement is to rule out a pneumo, not for tip placement.

    PICC lines however are a different story. The majority patients receiving PICC lines at my facility have their tip placement confirmed by ECG guidance and receive no CXR or other radiographic method of confirmation.
  2. 0
    Quote from aquaphone
    That's interesting about the PICC line placement. I've seen plenty of central lines placed, but I've never personally seen a PICC line placed. In my unit (MICU/SICU) the patients would always go off the unit for PICC placement.

    So I'm amazed at what you're saying; you really do use ECG as the only confirmation for PICC line? Have you actually been able to observe the procedure? How does it work?
    We use Sapiens:

    http://www.bardaccess.com/imaging-sapiens.php
    http://www.bardaccess.com/assets/pdf...CS_IFU_web.pdf

    I think Vasonova also makes one.
  3. 0
    Wow. Thanks for sharing, I had no idea!
  4. 0
    The 10 mL of air comment really scares me here. I too have heard (and done) bubble studies with TTE or TEE's, in which we use 1 mL of air and 10 mL's of saline, agitated with 2 syringes and a stopcock. But never for placement of a line.

    That study is more for vascular flow, specifically looking for R to L shunting...

    10 mL of air is more than enough to kill someone.....
  5. 0
    first of all: ECG

    the clinical use of a new ECG-guided central venous catheter with regard to positioning in the superior vena caves (SVC) was tested in some studies.
    most of researcher observed an intra-atrial p-wave (p-atriale). then for extra confirmation of
    Study Objective: To evaluate the clinical use of a new ECG-guided central venous catheter with regard to positioning in the superior vena caves (SVC).
    Design: Prospective study.
    Setting: Operating rooms of a university hospital and a general hospital.
    Patients: 89 elective and emergency adult surgical patients requiring central venous catheterization perioperatively.
    Interventions: We performed ECG-guided placement of the central venous catheter from several insertion sites. After we observed an intra-atrial p-wave (p-atriale), the catheter was withdrawn 3 cm back into the SVC. Postoperative anterior-posterior chest radiographs were performed for verification of tip localization.
    the result of their study showed that the Use of this wire-conducted intravascularECG signal is a reliable tool for positioning the central venous catheter via various insertion sites.
  6. 0
    Initial confirmation of PICC line tip location:
    • Upper extremity vessel: Obtain an A/P chest X-ray with the arms in adduction and the head turned away from the side of placement. Successful central placement in the superior vena cava, (SVC) is above the pericardial reflection line. If the tip cannot be clearly visualized a right posterior oblique film, 20 degrees off midline) should be taken.
    • Lower extremity vessel: Obtain two X-ray views of the abdomen, one A/P and one cross table lateral. Successful central tip placement is in the inferior vena cava, (IVC)
    Monitoring PICC line tip location during line maintenance:
    • Weekly and as needed monitoring of PICC lines with appropriate X-ray studies with discussion of current tip location in rounds and documentation when appropriate in the progress note.
    • Documentation of tip location when seen on routine X-rays in progress notes.
  7. 0
    in conclusion:

    There is no confirmation method that can be used with 100% certainty
    Transduce: This option is only available in the ICU. The small catheter found in the CVC kit, if not held firmly in place, may slip out of the vessel, making the guidewire impossible to pass and necessitating a second puncture.
    Hold up pressure tubing: This may be misleading in patients with very elevated CVPs and This may increase the risk of air embolus
    ABG/VBG Comparison: This may be misleading in patients with low flow states or severe hypoxemia.
    Ultrasound Confirmation of Guidewire Placement
    air flush usally is not part of today cliniccal practice
  8. 0
    Yeah, the 10mL of air was from a test question. Guess it was a trick question, lol.

    Quote from MikeRNWI
    The 10 mL of air comment really scares me here. I too have heard (and done) bubble studies with TTE or TEE's, in which we use 1 mL of air and 10 mL's of saline, agitated with 2 syringes and a stopcock. But never for placement of a line.

    That study is more for vascular flow, specifically looking for R to L shunting...

    10 mL of air is more than enough to kill someone.....
  9. 0
    Of bigger concern to me is the question of where in the US would we be placing CL's without immediate use of a CXR machine...I mean, it is 2011 here...

    And as far as the 10 ml of air question...I pity the soul stupid enough to even consider such a dumb idea!


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