Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts: A Valid and Cost-Effective Technical Simplification

Giuseppe Maria Della Pepa, Giovanni Sabatino, Elisabetta Peppucci, Carmelo Lucio Sturiale, Alessio Albanese, Alfredo Puca, Alessandro Olivi, Enrico Marchese, Valerio Perotti

Research output: Contribution to journalArticle

Abstract

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.

LanguageEnglish (US)
Pages455-459
Number of pages5
JournalWorld Neurosurgery
Volume109
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Electrocardiography
Costs and Cost Analysis
Radiography
Catheters
Central Venous Catheters
Hydrocephalus
Superior Vena Cava
Fluoroscopy
Jugular Veins
Heart Atria
Punctures
Thorax
Equipment and Supplies
Therapeutics

Keywords

  • CVC placement
  • ECG-guided technique
  • EKG-guided technique
  • Hydrocephalus
  • VA shunt
  • Ventriculoatrial shunt
  • Ventriculoperitoneal shunt
  • VP shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Della Pepa, G. M., Sabatino, G., Peppucci, E., Sturiale, C. L., Albanese, A., Puca, A., ... Perotti, V. (2018). Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts: A Valid and Cost-Effective Technical Simplification. World Neurosurgery, 109, 455-459. DOI: 10.1016/j.wneu.2017.10.123

Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts : A Valid and Cost-Effective Technical Simplification. / Della Pepa, Giuseppe Maria; Sabatino, Giovanni; Peppucci, Elisabetta; Sturiale, Carmelo Lucio; Albanese, Alessio; Puca, Alfredo; Olivi, Alessandro; Marchese, Enrico; Perotti, Valerio.

In: World Neurosurgery, Vol. 109, 01.01.2018, p. 455-459.

Research output: Contribution to journalArticle

Della Pepa, GM, Sabatino, G, Peppucci, E, Sturiale, CL, Albanese, A, Puca, A, Olivi, A, Marchese, E & Perotti, V 2018, 'Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts: A Valid and Cost-Effective Technical Simplification' World Neurosurgery, vol 109, pp. 455-459. DOI: 10.1016/j.wneu.2017.10.123
Della Pepa GM, Sabatino G, Peppucci E, Sturiale CL, Albanese A, Puca A et al. Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts: A Valid and Cost-Effective Technical Simplification. World Neurosurgery. 2018 Jan 1;109:455-459. Available from, DOI: 10.1016/j.wneu.2017.10.123
Della Pepa, Giuseppe Maria ; Sabatino, Giovanni ; Peppucci, Elisabetta ; Sturiale, Carmelo Lucio ; Albanese, Alessio ; Puca, Alfredo ; Olivi, Alessandro ; Marchese, Enrico ; Perotti, Valerio. / Electrocardiographic-Guided Technique for Placement of Ventriculoatrial Shunts : A Valid and Cost-Effective Technical Simplification. In: World Neurosurgery. 2018 ; Vol. 109. pp. 455-459
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abstract = "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.",
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N2 - 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.

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