Internal Medicine and Medical Investigation Journal

ISSN: 2474-7750

Assessment of Central Venous Catheterization Using Electrocardio-graphic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior?


Author(s): Mojtaba Mansouri1, Gholamreza Massoumi1, Ali Akbar Shateri

Central venous catheterization is usually performed during

major surgeries for central venous pressure assessment and fluid therapy. Va


riety of techniques is employed in central venous catheterization but the

information about pediatrics usage is limited. In this study we compared the

electrocardiographic technique with landmark one for central venous catheter



Materials and Methods:

This is a cross-sectional study in 75 patients

who underwent central venous catheterization for elective cardiovascular tho


racic surgery. In the first step, the location of catheterization was estimated

based on body surface landmarks. Then catheterization was done using elec


trocardiography. Then with cardio-surgeons aid, during open cardiac surgery,

the catheter tip location was found (gold standard). Finally, chest X-ray was

taken and catheter place based on radiological markers was recorded.


In this study 75 children with age under 18 years were included. The gender

distribution was 42.7% females and 57.3% males. The mean depth of central

venous catheter in gold standard method was 7.5±1.35cm. Significant associ


ation between central venous catheter placement in gold standard technique

and both landmark and electrocardiographic was seen (P-value<0.001; r=0.94

and P-value<0.001; r=0.77). Logistic regression showed a significant asso


ciation between weight and placement of catheter tip in landmark technique

(P-value=0.038) as the following formula (Depth of central venous catheter=



Our study showed that the use of electrocar


diographic for central venous catheterization considering carina-to-tip as ref


erence was superior to the landmark. In addition, the correct position of cathe


ter tip was affected by weight but not by height based on landmark technique

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