A Randomized Controlled Trial Comparing Electrocardiography Guided Technique and Anatomical Based Technique for Ideal Positioning of Dialysis Catheter Tip in Pediatric Patients

Moharam, Saad Ahmed; Elghoul, Sara Mabrouk; Elshikh, Amgad; ElSharkawy, Mohammed Said; Shaheen, Mostafa Mohamed

doi:10.21608/egja.2025.364822.1022

A Randomized Controlled Trial Comparing Electrocardiography Guided Technique and Anatomical Based Technique for Ideal Positioning of Dialysis Catheter Tip in Pediatric Patients

Document Type : Original Article

Authors

¹ Anesthesiology, Department of Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.

² Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

³ Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt

⁴ Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

⁵ Anesthesiology, Surgical ICU and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

10.21608/egja.2025.364822.1022

Abstract

Background: A dialysis catheter is the first choice of vascular access in urgent hemodialysis. Nevertheless, accurate estimation of the catheter length as well as precise tip placement remain crucial to prevent adverse consequences. This work aimed to compare the efficacy of ECG-guided and anatomical landmark techniques in detecting the best dialysis catheter tip’s position.
Methods: This prospective randomized controlled study involved 150 children and adolescents aged between five and eighteen years, both sexes, requiring catheter placement for acute as well as chronic renal failure indications. All participants went through an equal categorization into two groups: Group A (control) involved participants who had the dialysis catheter placed utilizing the anatomical landmark approach, and the ECG-guided technique in Group B.
Results: Age, sex, weight, height, insertion time, and catheter failure were insignificantly different among both groups. Mispositioned catheter tip, over-insertion, and arrhythmia exhibited insignificant values within group B as opposed to group A. Pneumothorax did not occur in any patient of the ECG group or control group.
Conclusion: In pediatrics, the ECG-guided approach exhibited superior precision as well as effectiveness while inserting the catheter tip as opposed to the anatomical landmark one concerning ideal placement, insertion depth as well as fewer negative consequences.

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