Letters to the Editor: Letters & Announcements
Drs. Schulz-Stübner1 and Schummer2 are correct in that we did not mention electrocardiogram positioning as a tool to verify correct positioning of a central venous catheter (CVC). However, our goal3 was to increase awareness of how to prevent CVC-induced cardiac tamponade by positioning the CVC tip outside the pericardial reflection. Electrocardiogram-guided CVC positioning places the CVC tip at the sinoatrial node, near the cava-atrial junction. Left in this position, the tip of the CVC will be inside the pericardial reflection and the CVC tip must be withdrawn an additional 2 cm for final proper positioning.4 Therefore, this technique is not superior to other techniques nor does it spare chest radiograph.
Personally, after reading the report by Kim et al.,5 I position the tip of any right-sided CVC at 11 to 12 cm depth and left-sided CVC at 12 to 13 cm. Proper positioning outside pericardial reflection was proved by chest radiographs in all cases. This approach spares unnecessary use of expensive equipment with the same patient benefit.
Micha Y. Shamir, MD
Department of Anesthesiology
Hadassah-Hebrew University Medical Center
1. Schulz-Stübner S. Confirmation of central venous catheter position by electrocardiogram. Anesth Analg 2011;113:1521
2. Schummer W. Catheter-induced cardiac tamponade: a preventable complication. Anesth Analg 2011;113:1521
3. Shamir MY, Bruce LJ. Central venous catheter-induced cardiac tamponade: a preventable complication. Anesth Analg 2011;112:1280–1
4. Gebhard RE, Szmuk P, Pivalizza EG, Melnikov V, Vogt C, Warters RD. The accuracy of electrocardiogram-controlled central line placement. Anesth Analg 2007;104:65–70
5. 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