© 2011 Wichtig Editore - ISSN 1129-7298 J Vasc Access ( 2011; 4): 348-353 12 - 348 DOI: 10.5301/JVA.2011.8380 ORIGINAL ARTICLE studies (4, 5). This technique would be particularly useful in oncologic patients, in whom long-term central venous catheters are increasingly used to infuse chemotherapy (6, 7). Venous thrombosis may ensue as a consequence of me- chanical and drug-related endothelial lesions and cathe- ter-related local blood flow alterations, and may be linked to a non-optimal catheter placement (8). Catheter-related thrombosis may lead to catheter malfunction and/or infec- tion and removal, thus increasing morbidity, mortality and costs (9). In this study, we prospectively assessed the effi- cacy and safety of the endovascular electrocardiographic technique to guide placement of long-term central venous catheters in a population of oncologic patients. Both the rate of correct catheter placement and the incidence of catheter-related thrombosis were considered, and a com- parison was made with the anthropometric technique. MATERIALS AND METHODS The study was performed on a cohort of cancer pa- tients aged >18; the patients underwent insertion of totally INTRODUCTION The correct insertion technique for long-term cen- tral venous catheters includes the lowest number of ve- nous attempts and a standardized method for placement of catheters’ tip (1, 2). The optimal position for the tip is widely considered to be the atrio-caval junction, where blood flow is high and the endothelium is distant from the catheter (3). To guide placement of long-term catheters, radioscopy has been considered the gold-standard tech- nique and used for a long time. However, it is a costly method, which exposes both operators and patients to x- rays, and many clinicians prefer to use different techniques (2). Alternatives include anthropometric calculations and endovascular electrocardiography (1). Endovascular ECG, which enables the operator to follow the progression of the catheter towards the atrio-caval junction by means of variations in electrocardiographic waves, was developed in 1949 and is an economic and safe alternative to radios- copy. However widely utilized, there is still lack of conclu- sive evidence about its efficacy, particularly for implant- able long-term catheters, because of a lack of prospective Endovascular electrocardiography to guide placement of totally implantable central venous catheters in oncologic patients Cecilia Pelagatti, Gianluca Villa, Andrea Casini, Cosimo Chelazzi, Angelo Raffaele De Gaudio Department of Critical Care, Section of Anesthesiology and Intensive Care, University of Florence, Florence - Italy ABSTRACT Purpose: Appropriate tip position of totally implantable central venous catheters is essential in order to prevent catheter- related complications, in particular thrombosis. Endovascular electrocardiography is an economic and safe method to guide placement of catheters into the central veins. Although widely utilized, there is still lack of conclusive evidence about its efficacy. The aim of the study was to assess the efficacy and safety of endovascular electrocardiographic guided placement compared to the anthropometric method. Methods: Endovascular ECG was employed to guide electrocardiographic placement of a central venous catheter in a co- hort of oncologic patients. The rate of correct placement and the incidence of catheter-related thrombosis were considered. Patients in which central venous catheters were inserted with the anthropometric technique were considered as control group. Results: The rate of correct placement was 91% and 50% for ECG-guided and anthropometric catheters (p<0.0001) respec- tively. None of the patients suffered from early insertion-related complications. The rate of catheter-related vascular throm- bosis was lower for ECG-guided catheters (3.6% vs. 9.6%, n.s.), in particular for left-inserted catheters (0% vs. 33.3%, p=0.02). Conclusion: Endovascular electrocardiography was more effective than the anthropometric technique in placement of im- plantable central venous catheters and was associated with a lower incidence of catheter-related thrombosis, in particular for those inserted from the left-side. Key words: Electrocardiography, Implantable catheters, Vascular thrombosis Accepted: February 12, 2011 JVA_10_1089