Letters to the Editor: Letters & Announcements
To the Editor
Kim et al.1 described the results of using surface landmarks to estimate the location of the tip of a percutaneously inserted central venous catheter (CVC). In their discussion, they also mentioned that using electrocardiogram (ECG)-guided confirmation of the catheter tip, although useful, is not a routinely used method (presumably in Korea as well as in the United States [US]) because of the need for additional equipment and cost. However, in German anesthesia departments and intensive care units, this technique is frequently used as a routine confirmatory test.2 It remains speculative why it has not gained widespread use in the US given the medicolegal implications of a misplaced CVC and the occasional delayed availability of chest radiographs as well as the need for secondary manipulations of the catheter, which could also be an infection control concern.
Therefore, it is troubling that the accompanying editorial by Shamir and Bruce3 gives recommendations to use “all available modalities for prevention of harm” without mentioning ECG-guided placement.
It is time to make existing reliable technology4 including switch boxes and adapters for ECG-guided confirmation of CVCs readily available on the US market.
Sebastian Schulz-Stübner, MD, PhD
Deutsches Beratungszentrum für Hygiene
des Universitätsklinikums Freiburg
Freiburg im Breisgau, Germany
1. Kim MC, Kim KS, Choi YK, Kim DS, Kwon M, Sung JK, Moon JY, Kang JM. An estimation of right- and left-sided central venous catheter insertion depth using measurements of surface landmarks along the course of central veins. Anesth Analg 2011;112:1371–4
2. Schulz-Stübner S. ECG guidance for CVC placement. Anesth Analg 2002;95:502
3. Shamir MY, Bruce LJ. Central venous catheter-induced cardiac tamponade: a preventable complication. Anesth Analg 2011;112:1280–1
4. Kremser J, Kleemann F, Reinhart K, Schummer W. Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance. Br J Anaesth 2011;107:567–72