ABSTRACT 1—Central Venous Catheter Placement Using Electromagnetic Position Sensing:
Hans Starkhammer, MD, PhD, MatsBengtsson, MD, PhD, Donald A. Kay,
Alan R.Shapiro
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. Fift 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 or x-ray during CVC insertion.
The ability of the system to place the CVC tip in the optimal position is dependent upon 1) the accuracy of the landmark in approximating the optimal CVC position and 2) the accuracy of the instrument to place the catheter tip under the chosen landmark. Our data indicate that the system was able to place the catheter tip,on average, within: ±1.0 cm of the optimal position.
Our experience to date with the system indicates that in the majority of patients (with normal body constitution and venous anatomy), satisfactory CVC-tip placement can be achieved without perioperative fluoroscopy. The BioNavigation System provides an opportunity to eliminate the use of “blind” CVC placement procedures and to reduce or omit perioperative fluoroscopy or x-ray during CVC insertion. In addition, this innovative technology appears promising in the development of new placement procedures for other medical devices.
Journal Biomedical Instrumentation & Technology (1996; 30: 164-170)
ABSTRACT 2—Research in COST JUSTIFICATION
Chronic Venous Access: Bedside Placement Technique and Complications.
Goldfarb PM, Colwell D.
Long-tern tunneled venous access catheters have evolved into safe and useful tools. More than 80% of these are implanted in patients in operating rooms with fluoroscopic and anesthesia support. This article describes a technique for safely placing these catheters at the patient’s bedside and focuses on how to identify, prevent, and manage common complications associated with this procedure. This article also summarizes 8 years of the author’s personal experience with bedside placement and describes a hospital quality assurance study that evaluated the efficacy of bedside placement. The role of appropriately trained personnel is highlighted. The possibility of cost savings totaling millions of dollars is raised.
Goldfarb PM, Coldwell D., “Chronic venous access: bedside placement technique and complications”, Cancer Practice, 1994 July-August;2(4):279-83