Central venous catheter placement using electromagnetic position sensing: a clinical evaluation

A critical step in placing a central venous catheter (CVC) is positioning the catheter tip in a location just outside the heart in the lower superior vena cava. The authors report the clinical evaluation of a new commercially available system that uses electromagnetic technology to sense the position of a catheter tip during CVC insertion. Fifty catheters were implanted using fluoroscopy to monitor system accuracy. The catheters were accurately placed (within 2.5 cm of the desired optimal position) in 46 of the 50 cases (92%). In two patients with abnormal chest geometry (short, barrel chests), catheter tip location was difficult to determine. In two other cases, procedural difficulties unrelated to the system (difficulty in external landmark determination and unclear fluoroscopic view of the optimal position) resulted in catheter placement outside the targeted range. The electromagnetic system provides an opportunity to eliminate "blind" CVC placement procedures and to reduce or omit perioperative fluoroscopy of x-ray during CVC insertion.