Method of locating the tip of a central venous catheter

• US 7,794,407 B2
• Filed: 10/23/2006
• Issued: 09/14/2010
• Est. Priority Date: 10/23/2006
• Status: Active Grant

• Current Assignee: BARD Access Systems Incorporated (Becton, Dickinson & Co)
• Original Assignee: BARD Access Systems Incorporated (Becton, Dickinson & Co)
• Inventors: Rothenberg, Peter M.
• Primary Examiner(s): Evanisko; George R
• Assistant Examiner(s): EL-KAISSI, HIBA CARINE
• Application Number:
  US11/552,094
• Publication Number:
  US 20080097232A1
• Time in Patent Office: 1,422 Days
• Field of Search: 600/508, 600/509, 600/510, 607/28, 607/122
• US Class Current: 600/508
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/065 Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/353 Detecting P-waves
• CPC Class Codes: A61B 5/6852 Catheters

Abstract

The invention includes a method of locating a tip of a central venous catheter (“CVC”) having a distal and proximal pair of electrodes disposed within the superior vena cava, right atrium, and/or right ventricle. The method includes obtaining a distal and proximal electrical signal from the distal and proximal pair and using those signals to generate a distal and proximal P wave, respectively. A deflection value is determined for each of the P waves. A ratio of the deflection values is then used to determine a location of the tip of the CVC. Optionally, the CVC may include a reference pair of electrodes disposed within the superior vena cava from which a reference deflection value may be obtained. A ratio of one of the other deflection values to the reference deflection value may be used to determine the location of the tip of the CVC.

Claims

1. A method of locating a tip of a central venous catheter, the central venous catheter having a portion disposed within the superior vena cava, a distal pair of electrodes, and a proximal pair of electrodes spaced longitudinally from the distal pair of electrodes, the method comprising:

obtaining a distal electrical signal from the distal pair of electrodes;

generating a first P wave from the distal electrical signal;

determining a first deflection value of the first P wave;

obtaining a proximal electrical signal from the proximal pair of electrodes;

generating a second P wave from the proximal electrical signal;

determining a second deflection value of the second P wave;

calculating a first ratio from the first and second deflection values;

obtaining a SVC deflection value;

calculating a second ratio of one of the first and second deflection values to the SVC deflection value; and

determining a location of the tip of the central venous catheter based on the first ratio and the second ratio.

2. The method of claim 1, wherein determining the location of the tip of the central venous catheter based on the first ratio and the second ratio comprises:

comparing the first ratio to a maximum threshold value; and

concluding the tip of the central venous catheter is located in the right atrium if the first ratio is equal to or exceeds the maximum threshold value.

3. The method of claim 1, wherein determining the location of the tip of the central venous catheter based on the first ratio and the second ratio comprises:

comparing the first ratio to a minimum threshold value; and

concluding the tip of the central venous catheter is located in the right ventricle if the first ratio is equal to or less than the minimum threshold value.

4. The method of claim 1, wherein determining the location of the tip of the central venous catheter based on the first ratio and the second ratio comprises:

comparing the first ratio to a maximum threshold value and a minimum threshold value; and

concluding the tip may be located in either the superior vena cava or the right atrium if the first ratio is less than the maximum threshold value and greater than the minimum threshold value.

5. The method of claim 1, wherein the portion of the central venous catheter disposed within the superior vena cava has a reference pair of electrodes spaced longitudinally proximally from the proximal pair of electrodes, and obtaining the SVC deflection value comprises:

obtaining a reference electrical signal from the reference pair of electrodes;

generating a SVC P wave from the reference signal; and

determining the SVC deflection value from the SVC P wave.

6. The method of claim 5, wherein determining the location of the tip of the central venous catheter based on the first ratio and the second ratio comprises:

comparing the second ratio to a maximum threshold value; and

concluding the tip of the central venous catheter is located in the right atrium or right ventricle when the second ratio is equal to or exceeds the maximum threshold value.

7. The method of claim 1, wherein determining the SVC deflection value comprises:

positioning the distal pair of electrodes inside the superior vena cava;

obtaining a SVC electrical signal from the distal pair of electrodes;

generating a SVC P wave from the SVC signal; and

calculating the SVC deflection value from the SVC P wave.

8. The method of claim 1, wherein determining the SVC deflection value comprises:

positioning the proximal pair of electrodes inside the superior vena cava;

obtaining a SVC electrical signal from the proximal pair of electrodes;

generating a SVC P wave from the SVC signal; and

calculating the SVC deflection value from the SVC P wave.

9. The method of claim 1, wherein the first P wave comprises a maximum value and a minimum value;

calculating the first deflection value as a function of the first P wave comprises determining the larger of the absolute value of the maximum value and the absolute value of the minimum value when the maximum and minimum values have the same polarity; and

calculating the first deflection value as a function of the first P wave comprises totaling the absolute values of the maximum and minimum values when the maximum and minimum values have opposite polarities.