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Table of Contents  
LETTER TO EDITOR
Year : 2011  |  Volume : 5  |  Issue : 2  |  Page : 242-243  

Central venous catheter placement: An alternative of Certodyn® (Universal Adapter)


Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, NH-58, Meerut, India

Date of Web Publication9-Apr-2012

Correspondence Address:
Manish Jain
A-5, Padam Kunj, Kishan Flour Mill, Railway Road, Meerut - 25005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0259-1162.94798

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How to cite this article:
Jain M, Rastogi B, Singh V P, Gupta K. Central venous catheter placement: An alternative of Certodyn® (Universal Adapter). Anesth Essays Res 2011;5:242-3

How to cite this URL:
Jain M, Rastogi B, Singh V P, Gupta K. Central venous catheter placement: An alternative of Certodyn® (Universal Adapter). Anesth Essays Res [serial online] 2011 [cited 2019 Sep 15];5:242-3. Available from: http://www.aeronline.org/text.asp?2011/5/2/242/94798

Sir,

A use of central venous catheters (CVCs) is increasing day by day. Guidelines for CVCs positioning by FDA and other experts suggest that CVCs tip should not be placed in right atrium in order to avoid complications. [1],[2] ECG guided CVCs insertion is done with the help of ECG adapter (Certodyn® , B.Braun Medical). But this adapter is expensive and not easily available in developing countries.

Present innovation is an alternative to Certodyn® which is very simple to make and very cost effective to correctly identify CVC tip position during its insertion. Changes in 'P' wave amplitude is used as a guide to position CVCs.

  1. Two ECG Electrodes [Figure 1]a
  2. One 'U' shaped steel paper clip [Figure 1]c
    Figure 1: (a) Two ECG electrode. (b) One non plastic coated steel 'U' paper clip. (c) Adhered two ECG electrode (vertical view). (d) Adhered two ECG electrode with paper clip (horizontal view)

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  3. Certofix® (B.Braun.Medical, Bethlehem, PA)
  4. ECG monitor [Figure 2]a and b
    Figure 2: a: Showing normal ECG recording on standard monitor
    Figure 2: b: Showing peaked 'P' wave on ECG while putting CVC


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Two ECG electrodes were stick together by central sticky portion [Figure 1]c and [Figure 3]. Right Arm lead of ECG monitor was attached to one side of ECG electrode assembly and other leads of ECG monitor were attached to surface electrodes in usual manner. A paper clip was attached to other side on metallic tip of ECG electrode assembly [Figure 1]d and [Figure 3].
Figure 3: Whole assembly on patient

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CVC was inserted by usual Seldinger technique. A CVC (20 cm) was inserted over guide wire (50 cm) until 20 cm guide mark of CVC was at skin level. The guide wire was then withdrawn through the catheter until a mark on guide wire indicated the tip to be exactly positioned at the tip of catheter. Then alligator was clip attached to guide wire at indicated position. The other end of cable was attached to 'U' shaped paper clip [Figure 3]. The catheter with guide wire was slowly adjusted according to ECG guidance. 'P' wave on lead II was observed on ECG monitor [Figure 2]a. Peaked 'P' wave [Figure 2]b indicates CVCs position in RA (right atrium), then CVC with guide wire was withdrawn until 'P' wave return to normal configuration. After further withdrawal of CVC for another 2 cm, CVC was secured with skin sutures and dressing was done.

It is very important to confirm the correct position of CVCs tip. It should never be placed in right atrium. [1],[2] Improper placement of CVCs tip can result into many complications like pleural effusion, hydrothorax, hemothorax, hydromediastinum, pneumothorax, and pneumomediastinum. [3] Radiological method (X-Ray, Image intensifier, computed tomography) are practical and reliable tools for confirmation of depth of CVCs tips. However confirmation by this method is usually done several hours after the insertion of CVCs with extra financial burden on patients or hospital and radiation hazard to patient. Ultrasound have very limited role for aiding confirmation of tip placement. However it is very much useful to find-out correct puncture site.

We have developed a very simple and cost effective technique for correct placement of CVCs tip. Principle of our technique is same as that of Certodyn® . Materials used in our technique are easily available and simple to assemble on spot. Its performance is equivalent to Certodyn® . It has no side effects. Safety of patient is ensured and avoids unnecessary exposure to radiation. Hence we conclude that this simple, safe and easy to assemble alternative can be used for accurate positioning of CVCs, thus avoiding complications which are not only difficult to manage but also a financial burden on patient and hospital.

 
   References Top

1.Scott WL. Central venous catheters: And overview of food and drug administration activities. Surg Oncol Clin N Am 1995;4:377-93.  Back to cited text no. 1
[PUBMED]    
2.Bowdle TA. Complications of invasive monitoring. Anestheisol Clin North America 2002;20:571-88.  Back to cited text no. 2
    
3.Duntley P, Siever J, Korwes ML, Harpel K, Heffner JE. Vascular erosion by central venous catheters. Chest 1993;104:1633-8.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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