Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts: A Valid and Cost-Effective Technical Simplification
| Autor: | Alfredo Puca, Valerio Perotti, Alessio Albanese, Giovanni Sabatino, Elisabetta Peppucci, Alessandro Olivi, Carmelo Lucio Sturiale, Giuseppe Maria Della Pepa, Enrico Marchese |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Catheterization Central Venous medicine.medical_specialty Adolescent Cost-Benefit Analysis Radiography Settore MED/27 - NEUROCHIRURGIA Superior vena 030204 cardiovascular system & hematology Cerebral Ventricles Electrocardiography Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Fluoroscopy Heart Atria Internal jugular vein Aged Aged 80 and over medicine.diagnostic_test business.industry Middle Aged medicine.disease Cerebrospinal Fluid Shunts Hydrocephalus Surgery VA shunt Catheter Surgery Computer-Assisted Female Neurology (clinical) Radiology business Complication 030217 neurology & neurosurgery Shunt (electrical) |
| Zdroj: | World Neurosurgery. 109:455-459 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2017.10.123 |
| Popis: | Background Ventriculoatrial (VA) shunt is a routine technique for the treatment of hydrocephalus. The correct position at the superior vena cava–right atrium junction is generally assessed by radiography. We present the first experience of an alternative, nonradiographic technique to assess the distal end of the VA shunts through an electrocardiographic (EKG) method. The technique has developed from the large experience of central venous catheters (CVC) worldwide; the EKG-guided method is a common and validated alternative to standard radiologic control of the location of the tip of any CVC. Methods Five consecutive patients underwent VA shunt with venous catheter positioned with the EKG-guided technique. The position of the catheter tip was verified by standard chest radiography. Results Four men and 1 woman (mean age, 45.4 years) underwent VA shunt for hydrocephalus with the EKG-guided technique. The side of internal jugular vein puncture was the right side in 4 cases and the left side in 1 case. As confirmed by radiography, all VA shunt tips were located within the correct range. There was no radiologic evidence of procedure-related complication or catheters that had to be replaced. Conclusions The EKG-guided technique for VA shunts is as accurate as fluoroscopy, but simpler, more readily available, less expensive, safer, and more cost effective. It reduces the need of radiography and radiologic exposition for both patients and operators. The EKG method may be a valid and cost-effective alternative to standard radiologic control in VA shunts, as for any central venous access device, and could become the preferential method for confirming tip position during VA shunt surgery. |
| Databáze: | OpenAIRE |
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