Positioning of the Central Venous Catheter for Hemodialysis Using Wireless Intracavitary ECG: A Case Series and Narrative Review of the Literature

TL;DR

This study shows that using wireless intracavitary ECG can effectively confirm the correct placement of central venous catheters for hemodialysis, reducing the need for X-rays.

Contribution

The study demonstrates the practicality of using ECG-IC for CVC placement in hemodialysis patients, omitting X-ray confirmation in over 90% of cases.

Findings

ECG-IC confirmed correct CVC placement at the right cavoatrial junction in 11 patients.

Chest X-ray consistently verified ECG-IC results with no post-procedure complications.

Combining ECG-IC with ultrasound can eliminate the need for X-ray in over 90% of cases.

Abstract

This study aimed to evaluate the practicality and feasibility of using intracavitary electrocardiography to confirm the proper placement of a central venous catheter for hemodialysis. Central venous catheters are typically placed using an echo-guided technique based on anatomical landmarks, followed by X-ray confirmation. Anesthesiology guidelines recommend evaluating the intracavitary electrocardiogram during the procedure to verify the correct CVC placement. This study involved 11 patients without rhythm disturbances, in whom a central venous catheter was placed in the right internal jugular vein at our institute in 2024. The patient’s electrocardiogram was analyzed using the MAGELLANO® (Italy) device to identify changes in the P wave or QRS complex, which confirmed the CVC’s correct placement at the right cavoatrial junction. Thoracic ultrasound was used to identify the right internal jugular vein and exclude iatrogenic pneumothorax. A subsequent chest X-ray was performed to further confirm the correct placement. In addition, a non-systematic review of the most recent literature on this topic was conducted using the Database PubMed—United States National Library of Medicine. Chest X-ray consistently verified the correct placements identified by ECG-IC, with no post-procedure complications. ECG-IC is a straightforward, viable, and cost-effective technique with high sensitivity when administered by properly trained professionals. This approach, combining ultrasound-guided CVC placement in the right internal jugular vein and intracavitary ECG monitoring, can omit X-ray control in more than 90% of cases.

Figures