A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients

被引:81
作者
Andropoulos, DB
Stayer, SA
Bent, ST
Campos, CJ
Bezold, LI
Alvarez, M
Fraser, CD
机构
[1] Texas Childrens Hosp, Dept Anesthesiol, Div Pediat Cardiovasc Anesthesiol, Houston, TX 77030 USA
[2] Texas Childrens Hosp, Div Pediat Cardiol, Houston, TX 77030 USA
[3] Texas Childrens Hosp, Dept Diagnost Imaging, Houston, TX 77030 USA
[4] Texas Childrens Hosp, Div Congenital Heart Surg, Houston, TX 77030 USA
[5] Baylor Coll Med, Houston, TX 77030 USA
关键词
D O I
10.1097/00000539-199907000-00012
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Transesophageal echocardiography (TEE) and central venous catheter (CVC) placement are often used during congenital cardiac surgery. Complications of CVC placement include cardiac perforation, inadvertent arterial placement, and erroneous hemodynamic data from unrecognized malposition. In this study, we used a prospective, randomized, controlled design to evaluate the use of TEE to guide depth of insertion and confirm superior vena cava cannulation, and to improve the percentage of correctly placed CVCs and reduce complications of CVC placement. One hundred forty-five patients were studied. Eighty patients were randomized to have subclavian vein insertion, 64: to have internal jugular insertion, and 1 to have external jugular insertion of CVC. TEE-guided CVC placement resulted in 100% correct placement when assessed by preoperative TEE, versus 86% in the control group (72 of 72 vs 63 of 73; P = 0.01). There was no difference in correct placement between the two groups when assessed by postoperative chest radiograph (81.9% TEE versus 75.3% control; P = not significant). One significant complication, a superior vena cava perforation, occurred in the control group. Time to placement was 9.6 min in the TEE group versus 8.0 min in the control group (P = 0.015). Implications: Transesophageal echocardiography can be used to guide central venous catheter placement in con genital heart surgery. Central venous catheters that seem to be located high in the right atrium by chest radiograph in these patients are often actually in the superior vena cava and pose little risk of cardiac perforation.
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页码:65 / 70
页数:6
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