Schummer W. , Schummer C. , Schelenz C. , Brandes H. , Stock U

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Central venous catheters—the inability of ‘intra-atrial ECG’ to prove adequate positioning Schummer W. , Schummer C. , Schelenz C. , Brandes H. , Stock U. , Müller T. , Leder U. , Hüttemann E. British Journal of Anaesthesia Volume 93, Issue 2, Pages 193-198 (August 2004) DOI: 10.1093/bja/aeh191 Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 1 The echocardiographic junction between SVC and RA was defined as the superior edge (*) of the crista terminalis (white arrow). The catheter tip (black-white arrow) was usually identified as two closely spaced, parallel, bright echodense lines surrounding the darker fluid-filled lumen. Rapid flush of cephazolin 2 g in 20 ml normal saline was used to identify the distal end of the CVC by TOE. The microbubbles of the solution act as contrast medium. (LA, left atrium; RPA, right pulmonary artery.) British Journal of Anaesthesia 2004 93, 193-198DOI: (10.1093/bja/aeh191) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 2 Intravascular baseline ECG and an ECG after the first onset of an increase in P wave size in one of the pigs (P marked). The upper series belongs to the intra-arterial catheter (RCA, right carotid artery). The lower series was recorded from the i.v. catheter (LEJV, left external jugular vein). British Journal of Anaesthesia 2004 93, 193-198DOI: (10.1093/bja/aeh191) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 3 A left-sided thoracotomy was performed followed by opening of the veins, the aorta and the right atrium. Catheter tip positions were documented. This arrow points at the pericardial reflection, the lower catheter tip is positioned in the ascending aorta (AA), the venous catheter tip ends in the SVC (★). British Journal of Anaesthesia 2004 93, 193-198DOI: (10.1093/bja/aeh191) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions