Intra-atrial ECG guidance for positioning central vein catheters

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Intra-atrial ECG guidance for positioning central vein catheters Salmela L , Aromaa U British Journal of Anaesthesia Volume 92, Issue 4, Pages 599-601 (April 2004) DOI: 10.1093/bja/aeh535 Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 1 Patient ECG.3 (a) Catheter tip in lower SVC. (b) Catheter tip in lower SVC, now very close to atrium. (c) Catheter tip in upper atrium. Published with permission of the Editor of the American Journal of Anesthesiology and the author of the article in which the figure appeared. British Journal of Anaesthesia 2004 92, 599-601DOI: (10.1093/bja/aeh535) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 2 Schematic.4 1. Catheter tip in SVC, considerably above atrium. 2. Catheter tip in SVC, close to atrium. 3. Catheter tip in upper atrium. 4. Catheter tip in mid atrium, half the wave of depolarization is approaching it, and half is going away from it. 5. Catheter tip in lower atrium, the wave of depolarization entirely approaches the tip of the catheter. Ao=aorta; PA=pulmonary artery. Published with permission of the Canadian Journal of Anesthesia. (Source: Cucchiara et al. Can Anaesth Soc J 1980; 27: 572–3.) British Journal of Anaesthesia 2004 92, 599-601DOI: (10.1093/bja/aeh535) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 3 AP-chest X-rays of a patient with ankylosing spondylitis. The two films are from two successive days. The insertion depth of the left sided catheter has not changed. Note the increased distance from clavicle to the catheter tip on the second day. Extra-atrial position of the catheter tip had been confirmed by transoesophageal echocardiography on day 1. (a) Day 1, distance of catheter tip to clavicle=45.1 mm. (b) Day 2, distance of catheter tip to clavicle=69.6 mm. British Journal of Anaesthesia 2004 92, 599-601DOI: (10.1093/bja/aeh535) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions