Comparison of Accuracy in Central Venous Catheter Tip Placement in Right Sided Internal Jugular Vein Using Clinical and Endocavitory ECG Method in Elective Surgeries in a Tertiary Care Center

Introduction: Central venous catheter (CVC) insertion is a common and essential procedure in perioperative and critical care management. Accurate catheter tip placement is critical to avoid malposition and complications such as arrhythmia, vascular injury, and thrombosis. Conventionally, chest radiography has been used for confirmation, though it has limitations including time delay and radiation exposure. Materials and Methods: This prospective comparative study was conducted after obtaining Institutional Human Ethics Committee approval. A total of 90 patients undergoing elective cardiac surgery were randomized into two groups: Group A (fixed-depth insertion, n=45) and Group B (endocavitary ECG-guided insertion, n=45). Demographic details, type of procedure, number of attempts, threading difficulty, and complications were documented. Results: The baseline demographics, including age (59.5 ± 9.4 years in Group A vs. 60 ± 11.9 years in Group B, p=0.822), weight (66 ± 8.2 vs. 69.8 ± 16.9, p=0.207), and height (159 ± 5.1 vs. 161 ± 8.0, p=0.406), were comparable between groups. Most patients underwent CABG (84.4% vs. 91.1%). First-attempt success rates were similar (73.3% vs. 66.7%, p=0.49). Difficult threading occurred in 20% of Group A and 28.9% of Group B. Conclusion: Both fixed-depth and ECG-guided CVC insertions were safe and effective, with comparable complication rates. However, ECG guidance demonstrated a higher proportion of catheters positioned optimally at the SVC–RA junction, suggesting its value as a practical, real-time, and radiation-free method to improve accuracy and safety in CVC placement.