Original Articles
Published February 10, 2019
Article Tools
Article Level Metrics
Share this article
facebook twitter linkedin


Central venous catheterization

How to Cite

Mansouri, M., Massoumi, G., & Shateri, A. A. (2019). Assessment of Central Venous Catheterization Using Electrocardiographic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior?. Internal Medicine and Medical Investigation Journal, 4(1). https://doi.org/10.24200/imminv.v4i1.198

Assessment of Central Venous Catheterization Using Electrocardiographic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior?

Mojtaba Mansouri
Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
Gholamreza Massoumi
Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
Ali Akbar Shateri
Isfahan University of Medical Sciences, Isfahan, Iran

Introduction: Central venous catheterization has been usually performed during major surgeries in order of central venous pressure assessment and fluid therapy. Variety of techniques has been performed for central venous catheterization previously but the information in this regard about pediatrics is limited. In the current study, the comparison of electrocardiographic technique with landmark one for central venous catheterization performance has been done. 

Methods: This is a cross-sectional study conducted on 75 patients underwent central venous catheterization for elective cardiovascular thoracic surgery. In the first step, the location of catheterization was estimated based on body surface landmarks. Then catheterization was done using electrocardiography. Then by cardio-surgeon aid, during open cardiac surgery, the catheter tip location was found (gold standard). Finally, chest X-ray was taken and catheter place based on radiological markers was recorded.

Results: In the current study, 75 children with age under 18 years and gender distribution of 42.7% females and 57.3% males were assessed. Mean of central venous catheter depth in gold standard method was 7.5±1.35 centimeters. Significant association between central venous catheter placement in gold standard technique and both landmark and electrocardiographic was seen (P-value<0.001; r=0.94 and P-value<0.001; r=0.77). Logistic regression showed a significant association between weight and placement of catheter tip in landmark technique (P-value=0.038) as following formula (Depth of central venous catheter= 5.33+0.07*weight).

Conclusion: Our study showed that the use of ECG for CVC considering carina-to-tip as reference was superior to the landmark. In addition, catheter tip correct position was affected by weight but not height based on landmark technique.



Booth S, Norton B, Mulvey D. Central venous catheterization and fatal cardiac tamponade. British journal of anaesthesia. 2001;87(2):298-302.

Dougherty L, Bravery K, Gabriel J, Kayley J, Malster M, Scales K, et al. Standards for infusion therapy. Royal collage of nursing, Third edition London. 2010.

Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis R, Domino K, et al. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2012;116(3):539.

Barnwal NK, Dave ST, Dias R. A comparative study of two techniques (electrocardiogram-and landmark-guided) for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery. Indian journal of anaesthesia. 2016;60(7):470.

Naylor CL. Reduction of malposition in peripherally inserted central catheters with tip location system. Journal of the Association for Vascular Access. 2007;12(1):29-31.

Yoon S, Shin T, Kim H, Lee J, Kim C, Kim S, et al. Depth of a central venous catheter tip: length of insertion guideline for pediatric patients. Acta anaesthesiologica scandinavica. 2006;50(3):355-7.

Ryu H-G, Bahk J-H, Kim J-T, Lee J-H. Bedside prediction of the central venous catheter insertion depth. British journal of anaesthesia. 2007;98(2):225-7.

Ishizuka M, Nagata H, Takagi K, Kubota K. Right internal jugular vein is recommended for central venous catheterization. Journal of Investigative Surgery. 2010;23(2):110-4.

Pittiruti M, La Greca A, Scoppettuolo G. The electrocardiographic method for positioning the tip of central venous catheters. The journal of vascular access. 2011;12(4):280-91.

Yoon S, Shin J, Hahn S, Oh A, Kim H, Kim S, et al. Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients. British journal of anaesthesia. 2005;95(4):514-7.

Bailey PL, Glance LG, Eaton MP, Parshall B, McIntosh S. A survey of the use of ultrasound during central venous catheterization. Anesthesia & Analgesia. 2007;104(3):491-7.

Oliver Jr WC, Nuttall GA, Beynen FM, Raimundo HS, Abenstein JP, Arnold JJ. The incidence of artery puncture with central venous cannulation using a modified technique for detection and prevention of arterial cannulation. Journal of cardiothoracic and vascular anesthesia. 1997;11(7):851-5.

Albrecht K, Breitmeier D, Panning B, Tröger HD, Nave H. The carina as a landmark for central venous catheter placement in small children. European journal of pediatrics. 2006;165(4):264-6.

Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. British Journal of Anaesthesia. 2000;85(2):192-4.

Baldinelli F, Capozzoli G, Pedrazzoli R, Marzano N. Evaluation of the correct position of peripherally inserted central catheters: anatomical landmark vs. electrocardiographic technique. The journal of vascular access. 2015;16(5):394-8.

Chu K-S, Hsu J-H, Wang S-S, Tang C-S, Cheng K-I, Wang C-K, et al. Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography. Anesthesia & Analgesia. 2004;98(4):910-4.

Lee J-H, Bahk J-H, Ryu H-G, Jung C-W, Jeon Y. Comparison of the bedside central venous catheter placement techniques: landmark vs electrocardiogram guidance. British journal of anaesthesia. 2009;102(5):662-6.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.