ABSTRACT
A technique for electrocardiographic (ECG) guided percutaneous placement of central venous catheters (CVC) was studied in a prospective, randomized manner. In 34 patients, 51 ECG guided percutaneous CVC were compared with 29 blind percutaneous CVC in 23 patients. Thirty-nine percent of CVC placements were changes over a guide wire. Ideal catheter tip location at the atriocaval junction was achieved in 96 percent of the patients in the study versus 59 percent of those in the control group (p less than 0.001). In addition, we report 25 patients with open placement of CVC using intraoperative ECG guidance and fluoroscopic confirmation. Ideal location of the catheter tip was achieved in 100 percent of these patients. ECG guided CVC placement using the technique described herein obviates the need for catheter repositioning, repeat roentgenographic studies and intraoperative fluoroscopic imaging, along with the attendant costs and radiation exposure to staff and patient. Aberrant catheter tip placement and the associated morbidity are also eliminated.
Subject(s)
Catheterization, Central Venous/methods , Electrocardiography/methods , Monitoring, Physiologic/methods , Arrhythmias, Cardiac/etiology , Catheterization, Central Venous/economics , Catheterization, Central Venous/instrumentation , Cost Savings , Cost-Benefit Analysis , Electrocardiography/economics , Electrocardiography/instrumentation , Humans , Monitoring, Physiologic/economics , Monitoring, Physiologic/instrumentation , Prospective StudiesABSTRACT
Crack, the free-base form of cocaine, was introduced as an illicit street drug in 1986. Since then, we have noted a significant increase in acute gastroduodenal perforations. Between 1982 and 1986, we treated 11 patients with such perforations. This represents a constant occurrence rate of 6% of hospital admissions for peptic ulcer disease. Since 1986 we have treated 16 patients with gastroduodenal perforation, which yields an occurrence rate of 16%. Nine of the 16 patients had a close temporal relationship between the use of crack and the onset of their perforation. This group was younger and disproportionately comprised of male patients. These findings led us to believe that there may be a pathogenic relationship between the use of crack and acute gastroduodenal perforation, and the clinician should be aware of the various potential complications of this new drug. This relationship also raises questions about the exact pathophysiology of peptic ulcer disease.
Subject(s)
Cocaine , Duodenal Diseases/chemically induced , Intestinal Perforation/chemically induced , Stomach Diseases/chemically induced , Substance-Related Disorders/complications , Adult , Duodenal Diseases/surgery , Female , Humans , Illicit Drugs , Intestinal Perforation/surgery , Length of Stay , Male , Middle Aged , Peptic Ulcer/epidemiology , PylorusABSTRACT
A new technique is described for the percutaneous insertion of central venous catheters under direct ECG guidance, using the intraluminal column of saline solution as a transvenous electrode. This method is safe and allows the correct placement of the catheter tip in the superior vena cava, regardless of anatomic variations in the length of the central veins. It also identifies the aberrantly located catheter, thus preventing potential complications, such as irritation of the right ventricle by the catheter tip and extravascular infusion of solutes.
