Comparison of Landmark Versus ECG-Guided Technique for Correct Insertion of Central Venous Catheter in Paediatric Patients Undergoing Cardiothoracic Surgery

Abstract

Background: Central venous catheters are inserted in internal jugular vein during cardiac surgeries in all patients. However, the length of the catheter should be correctly estimated and the tip of the CVC should be correctly placed to avoid various complications. 
The primary objective of this study is to compare anatomical landmark technique versus using ECG-guided technique for the correct insertion length of the Central Venous Catheter.
Methods: Prospective, randomized, interventional study was conducted on 72 patients of <12 years age. Patients were randomly allotted to two groups of 36 patients each (landmark and ECG).
After induction, CVC cannulation was performed using either of the techniques in right IJV in all patients. Correct position of CVC was checked by obtaining post operative chest X rays in all patients. CVC tip position within 0.5cm above/below or at carina was considered as correct position. Using student t-tests and Chi square-tests analyses were performed.
Results: In landmark group, CVC was positioned correctly in 22(61.11%) out of 36 patients as compared to 33 (91.67%) in the ECG group, (P = 0.006). The mean depth of CVC insertion was 9.05±1.66 and 8.26±1.41 in the landmark and ECG group respectively (P= 0.032). The landmark group had 12 (33.33%) patients with complications during the procedure, as compared to 3(8.33%) in the ECG-guided group, (P = 0.020).
Conclusion: ECG-guided CVC insertion, a simple bedside technique was found more accurate with lesser complications for CVC tip placement than the landmark technique. ECG-guided CVC placement is therefore relatively more accurate, efficient, and safe.