[Use of electrocardiographic placement control of central venous catheters in Austria]

After placement of a central venous catheter the correct position of the catheter tip has to be verified. The use of intravascular ECG tracing via a guide-wire or via the saline-filled lumen of the catheter enables immediate and safe control of the position. Only if complications (e.g. pneumothorax) are suspected, further clinical and radiological diagnostics are necessary. Up to now, no data on the routine clinical use of this method are available. In April 1998, a semi-structured questionnaire was sent to the 518 heads of anaesthesiological, surgical and medical departments in Austria (33% of the questionnaires were returned). The subclavian (56%) and internal jugular veins (35%) are most frequently used for catheter insertion in Austria. Verification of the catheter tip placement by ECG-guidance is used in only 8% of cases, while radiographs are performed in most cases. Uncertainty with respect to forensic consequences of using the ECG-guidance for control of the catheter tip placement and the possible necessity of an additional radiograph are the main problems seen by the heads of the departments. After placement of a central venous line, measures for the verification of the catheter tip and measures for the control of possible complications have to be considered separately. Intravascular ECG tracing is unable to detect complications. Concerning the verification of the catheter tip position many studies confirm the easy handling, relevance of results and cost savings for this method. Its use for the control and documentation of the tip location is considered a standard. In Austria the consequent use of the method would offer the chance for significant reductions of treatment costs.