Anatomical Landmark Method for Paediatric Port Catheter Tip Positioning

Summary

This study looks at how to place port catheters safely and accurately in children who need long-term intravenous treatment.

For these treatments to work well and to avoid problems such as heart rhythm issues, blood clots, or infections, the tip of the catheter must be in the correct position inside a large vein near the heart.

Doctors commonly use two different methods to estimate the correct catheter length. One method uses body measurements and surface landmarks on the chest. The other method, called intracavitary electrocardiography (IC-ECG), uses changes in the heart's electrical signal during the procedure to guide placement.

In this study, researchers compared these two methods in children. They measured how closely the results of the two techniques matched and how much they differed.

After the catheter was placed, chest X-rays were used to check whether the catheter tip was in the correct position.

The goal of this study is to determine whether the simpler anatomical method can provide accurate and clinically reliable results compared to the IC-ECG method.

Conditions

• Central Venous Catheterization
• Vascular Access Devices
• Pediatric Patients
• Monitoring

Interventions

PROCEDURE

Anatomical Landmark Method

Port catheter placement procedures were performed under ultrasound guidance. To ensure correct positioning of the catheter tip, a length estimation method based on anatomical landmarks was used. This method was developed by reviewing contrast-enhanced chest computed tomography images of pediatric patients without thoracic deformities. In these images, the ideal catheter tip position was identified just above the junction of the superior vena cava and the right atrium. When this point was projected onto the chest wall, it most often corresponded to the upper border of the junction between the right third rib and the sternum. In clinical practice, the distance between the vascular puncture site and this anatomical landmark was measured on the skin using a ruler, and the catheter length was adjusted accordingly before placement.

PROCEDURE

Intracavitary Electrocardiography (IC-ECG)

For each patient, two catheter length measurements were obtained: one using anatomical landmarks and one using intracavitary electrocardiography. Although both measurements were recorded for comparison, the catheter was trimmed and placed according to the anatomical landmark method. Intracavitary electrocardiography is a safe and cost-effective method that allows real-time confirmation of catheter tip position. In this study, a modified approach was created using standard anesthesia monitors. After venous access was established, the proximal end of the sterile guidewire was connected to an electrocardiogram electrode placed on the right shoulder. As the guidewire was advanced, changes in the cardiac P-wave were monitored continuously. The point of maximum P-wave amplitude, corresponding to the junction of the superior vena cava and the right atrium, was identified, and the corresponding intravascular length was recorded.

Sponsors & Collaborators

• Ankara City Hospital Bilkent

  lead OTHER

Principal Investigators

• Çağrı Damar, Assoc Prof · Ankara City Hospital Bilkent

Eligibility

Min Age

1 Month

Max Age

17 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-11-01

Primary Completion

2025-04-30

Completion

2025-04-30

Countries

• Turkey (Türkiye)

Study Locations