The electrocardiographic method for positioning the tip of central venous access device.

The electrocardiographic method for positioning the tip of central venous access device. J Vasc Access. 2019 Sep 12;:1129729819874986 Authors: Yu Y, Yuan L Abstract BACKGROUND: The electrocardiogram-based insertion method is non-radiative, allowing real-time positioning verification and reducing the need for postoperative repositioning. METHODS: Relevant databases published from January 1990 to January 2019 in PubMed, Web of Knowledge, Medline and Ovid's database were searched, comparing the effectiveness of electrocardiogram-guided catheter tip positioning (electrocardiogram-guided group) and the landmarks-guided insertion plus chest X-ray confirmation (landmarks-guided group). The primary outcome was accurate catheter tip placement and the secondary outcomes were complications. RESULTS: A total of 13 studies were finally included with a total of 4988 patients, of whom 2789 cases were in the electrocardiogram-guided group and 2199 cases received landmarks-guided insertion plus chest X-ray. Compared with the landmarks-guided group, our meta-analysis showed that the electrocardiogram-guided group had a higher success rate of tip placement (odds ratio = 0.21, 95% confidence interval = 0.14-0.34, p 
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research

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Case submitted by Alex Bracey, Written by Alex Bracey and Pendell MeyersA man in his 70s complained of acute chest pain followed by witnessed cardiac arrest. He received immediate bystander CPR prior to EMS arrival. EMS found him in VF and administered 4 shocks, multiple doses of epinephrine, and amiodarone with intermittent ROSC, however he was in arrest on arrival to the ED with ongoing CPR via LUCAS device. Overall down time was 35 minutes from the time of arrest to arrival at the ED.First rhythm check in the ED showed PEA with a wide complex at a rate of approximately 30 bpm. Calcium and epinephine were given at CPR wa...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Discussion Pulmonary embolism (PE) is potentially life-threatening but fortunately rare event especially in the pediatric population. It was first described in children in 1861. PE is likely underreported because of minimal or non-specific clinical symptoms. The incidence is estimated at 0.05-4.2% with the 4.2% based on autopsy reports. It is probably also increasing as more central venous catheters (CVC) are used, and more children are surviving previously poor prognostic diseases. There is a bimodal distribution with cases
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Authors: Hignell ER, Phelps J Abstract Central venous catheters are widely used in intensive care and critically unwell patients, and reporting of unusual complications is in the interest of those using them on a regular basis. Recognised complications involve vascular, cardiac and pulmonary systems and include the risk of infection. Described is a case with a recurrent complication of device failure secondary to migration of the central venous catheter tip as a result of recurrent coughing episodes. The approach to inserting central catheters and diagnosing the cause for the migration is discussed. This case direc...
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
CONCLUSION: Due to the small number and low quality of identified studies, it is difficult to draw definitive conclusions on the relative effectiveness and safety of guide wire versus liquid electrodes for the placement of central venous catheters in adults. More well-designed studies are needed in the future. PMID: 31422729 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
Conclusion: We conclude that both landmark guidance and ECG guidance are comparable with regard to accurate central venous catheter tip positioning when CVCs are placed through right internal jugular vein whereas formula based technique is least accurate and results in over insertion of CVCs.
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
CONCLUSION:: A modified intracavitary electrocardiographic technique can be safely used for detecting the location of the tip of central venous catheters in atrial fibrillation patients: the highest activity of the f waves is an accurate indicator of the location of the tip at the cavo-atrial junction. PMID: 30596473 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
Conclusion: ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. Furthermore, the ECG-guided technique was more time-effective and had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe and can be considered as an alternative method to conventional radiography for confirmation of CVC tip placement.
Source: Journal of Emergencies, Trauma and Shock - Category: Emergency Medicine Authors: Source Type: research
Rationale: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. Patient concerns: An 81-year-old man was brought to the emergency department because of consciousness disturba...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
CONCLUSION: Our study could not demonstrate any specific advantage of Sherlock-3CG either as a magnetic-based tip navigation method or as an electrocardiogram-based tip location method. PMID: 30334475 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique. Methods: Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and afte...
Source: The Indian Journal of Medical Research - Category: Biomedical Science Authors: Tags: Indian J Med Res Source Type: research
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