Comparison of intra-atrial ECG with Peres' formula in assessing the accuracy of central venous catheter depth in the right internal jugular vein at the ICU

Introduction: Central Venous Catheterization (CVC) is a routine interventional procedure that plays an important role in the management of critical patients. Improper position of the central venous catheter (CVC) can cause serious complications, including perforation of the heart or large blood vessels. Methods that can be used to assist in the placement of CVC depth are the Peres formula and the use of intra-atrial ECG.
This study aims to determine the more precise depth accuracy between the use of intra-atrial ECG compared to the accuracy of the Peres formula in determining the correct CVC depth at Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Bali.
Materials and method: The method of this research is a Randomized Control Trial with a consecutive sampling technique. This study is an experimental clinical trial that divides subjects into 2 groups: the intra-atrial ECG assessment technique group and the group with the Peres formula. Every eligible subject was randomized so they had an equal chance of being selected into each group. Inclusion criteria: Indonesian race patients aged 18–65 years who will undergo jugular CVC placement according to indications and a height of 140–180 cm. Exclusion criteria: Patients with BMI > 40 kg/m², patients with arrhythmias (Atrial fibrillation, atrial flutter, ventricular fibrillation, supraventricular tachycardia), patients with severe heart failure, and patients with blood clotting disorders (prolonged hemostasis function). Descriptive analysis, proportion comparison analysis with the Chi-square test to determine the risk ratio (RR), 95% Confidence Interval (CI), and P-value at the limit of α < 0.01 using SPSS statistical software.
Results and Discussion: The results for age showed the intra-atrial ECG group had a mean age of 40.94±14.43 years and the Peres group had a mean of 45.44±15.53 years. Gender in both groups was predominantly male. BMI results in the intra-atrial ECG group showed a normal mean BMI (22.76±2.59 kg/m²), while the Peres group had an overweight mean (23.13±2.48 kg/m²). CVC depth in the intra-atrial ECG group had a mean of 16.14±0.90 cm and in the Peres group a mean of 16.42±0.57 cm. Chi-Square results showed intra-atrial ECG has an RR of 2.3 (95% CI 1.25-4.17) and p 0.002 compared to the use of the Peres formula.
Conclusion: Intra-atrial ECG has an accuracy in assessing the depth of the central venous catheter in the right internal jugular vein two point three times greater than using the Peres formula in the ICU of Prof. Dr. IGNG Ngoerah General Hospital Denpasar.