[Incorrect placement of a vena cava catheter and its prevention by intra-atrial ECG]

Up to now, radiological position control was obligatory due to the frequent complications arising from false cava catheter positioning. Apart from the radiological control, which is time consuming and expensive and involves the danger of allergic reactions due to contrast media, intraatrial ECG-recording can be applied to achieve correct positioning of the catheter tip. By this method exact placement of the catheter tip in the superior vena cava was possible in 98 of 100 cases examined. Only 2 catheters could not be placed: one was placed intra-arterially, and the other could not pass a venous valve. The method proved to be inexpensive, time saving and could even be applied in emergency situations (intraoperatively). Important prerequisites for the success of the procedure are a disturbance-free ECG-derivation, a sinus rhythm, and sufficient practical experience on the part of the examiner with regard to the assessment of intra-atrial ECG-alterations.