Abstract
Taking into account the hazards of blindly positioning of catheter tips and the full subcutaneous implantation of ports, it is important to assess a correct catheter tip location during insertion of the device, for later corrections are cumbersome or impossible without a new procedure. Perioperative fluoroscopy was considered as the golden standard for this control as it allows to visualise the catheter in situ and to perform correcting manoeuvres when needed. This can be done under direct 2-dimentional real-time imaging, but patients and care providers are repeatedly exposed to a small amount of radiation, and false-positive results are not fully ruled out. An alternative assessment method, based on electrocardiographic principles, could be useful to determine the best location for the catheter tip and to assist precise positioning. Indeed, the shape of the intravasal electrocardiogram waves (IEG) is closely related to the place where they are captured. Tracking changes in the IEG pattern, mainly involving the P-wave of the ECG complex taken inside large vessels or heart allows thus to position catheter tips very accurately. For this technique, a conductive solution or a metallic guidewire can be used as guidance systems. This chapter will describe the theoretical basis of the Intravasal Electrogram and its application to perioperative central catheter positioning, and will provide a comparison with fluoroscopic performances.
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© 2012 Springer-Verlag Italia
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Stas, M., Willems, R. (2012). Verifying Catheter Tip Position: Fluoroscopy vs Intravasal Electrogram. In: Di Carlo, I., Biffi, R. (eds) Totally Implantable Venous Access Devices. Springer, Milano. https://doi.org/10.1007/978-88-470-2373-4_10
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DOI: https://doi.org/10.1007/978-88-470-2373-4_10
Publisher Name: Springer, Milano
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