Intra-cavitary ECG is an effective method for correct positioning the tip of tunneled Groshong catheters.

BACKGROUND: Intra-cavitary electrocardiography (ECG) is a well-known method for correct positioning of the tip of central venous catheters (CVC). A significant increase in the P wave, as registered by the intra-cavitary electrode, signals the entrance of the catheter into the right atrium.

METHODS: In this prospective observational study, 155 consecutive oncologic patients were enrolled for cannulation of the right or left internal jugular vein for insertion of a tunneled Groshong catheter. In 150 patients the tip was positioned by means of intracavitary ECG. Five patients with atrial fibrillation (N=4) or pacemaker in place (N=1) were excluded from the study. As the P-wave amplitude began to increase, the catheter was secured in that position and the insertion depth was registered.

RESULTS: Intra-cavitary ECG was always apt to detect the increase in the P wave. On the post-operative chest x-ray all Groshong catheters except two were in the correct position.

CONCLUSIONS: The need for chest x-ray or fluoroscopy may be virtually eliminated by using the ECG technique.