Monitoring of Central Dual-Lumen Catheter Placement in Haemodialysis by Endocavitary Electrocardiography: A Simple and Safe Technique for the Clinical Nephrologist

Abstract

Complications in the placement of central venous catheter (CVC) may occur in up to 20% of cases. The catheter can be misplaced in the contralateral brachiocephalic vein, the ipsi or controlateral internal jugular vein, and usually a chest X-ray is necessary to evaluate its location. We believe that the best technique, first described by Serafini et al, to establish the position of a CVC is the endocavitary electrocardiography (EC-ECG) and its employment is recommended in all uraemic patients requiring haemodialysis. This technique uses the tip of the CVC as reference lead in a standard electrocardiograph. The best use of this technique has been obtained by echotomographic visualization of the internal jugular vein executed just before transcutaneous puncture of the vessel. From 1991 to December 1999 we have successfully applied this technique in CVC placement in 612 patients requiring haemodialysis. In our opinion, this method is a safe and simple technique that avoids the need for thoracic X-ray controls and time lost waiting for radiographs that prolong the start of the haemodialysis session. According to our experience, we believe that the EC-ECG technique is a method in compliance with Food and Drug Administration guidelines regarding catheter tip location in uraemic patients.