Intracardiac (superior vena cava/right atrial) ECGs using saline solution as the conductive medium for the proper positioning of the Shiley hemodialysis catheter: is it not time to forego [correction of forgo] the postinsertion chest radiograph?

Abstract

Hemodialysis (HD) is often administered in critical care areas to patients with chronic renal failure as a continuation of the HD they are receiving on an ambulatory basis, and to patients who develop such a need for the first time or may require HD only transiently. The double-lumen Shiley central venous catheter (SCVC), inserted via the brachiocephalic veins, is often employed for HD, and it is customary to obtain a chest radiograph to ensure proper positioning of the tip of the SCVC within the superior vena cava (SVC) or high right atrium (RA). This practice is implemented to evaluate for complications stemming from the insertion of the SCVC and subsequent mishaps due to low positioning of the tip of the catheter in the RA or right ventricle. Intracardiac ECGs obtained via a saline solution-filled SCVC as the conductive medium can be easily recorded serially and periprocedurally to ensure proper positioning of the tip of the SCVC in the SVC or high RA based on the evaluation of the appearance and amplitude of atrial depolarization, thus rendering chest radiographs redundant.