A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial

Abstract

Background: The present study aimed to investigate the P-wave changes in intracavitary electrocardiography (IC-ECG) during catheterization with a peripherally inserted central catheter (PICC) in order to provide guidance for the accurate localization of the tip of the PICC.Methods: A total of 106 newborns who needed a PICC were randomly divided into two groups-a study group and a control group-using a random number table, with 53 cases in each group. In the study group, the ECG monitor was connected after the successful puncture and insertion of the PICC into the right sternoclavicular joint, and the position of the catheter tip was determined according to the P-wave changes on the IC-ECG. Localization X-rays were taken at the same time. In the control group, after the successful routine puncture and insertion of the PICC into the location to a predetermined length, localization X-rays were taken. The accuracy, procedure duration, and cost of the two localization methods were evaluated. Results:The accuracy of the localization in the study group was 92.5%, but the difference was not significant when compared with the control group (P>0.05). The duration of the procedure in the study group was 5.12±1.57 minutes, and the cost was 7.12±0.56 yuan, both of which were significantly different when compared with the control group (P<0.05).Conclusions: P-wave changes during IC-ECG have high accuracy in determining the location of the tip of the PICC. It is also a simple method and has certain clinical application value.

Tecnologias para manutenção do Cateter Central de Inserção Periférica em neonatos: revisão integrativa

“…Foram 20 (62,5%) os artigos incluídos que abordaram o posicionamento do PICC no recém-nascido; onze (34,4%) apresentaram estratégias de posicionamento ideal do cateter por meio de USG e ecocardiografia, [26][27][34][35][36][37][38][39][40][41][42] um (3,1%) o USG em associação com infusão de solução salina agitada, 43 seis (18,8%) a eletrocardiografia intracavitária, 24,[44][45][46][47][48] e dois (6,3%) a radiografia. 16,49 Dos cateteres considerados bem-posicionados por meio de radiografia, 25% estavam em posição intracardíaca na avaliação por USG.…”

“…24,[44][45][46][47][48] A ecocardiografia intracavitária verifica o posicionamento do PICC na veia cava por meio de alterações na onda P quando a ponta do cateter atinge a veia cava na junção atrial. [60][61] Os artigos demonstraram sucesso no uso do ECG para o posicionamento adequado do PICC, 24,[44][45][46][47][48] sendo considerado um método acessível e confiável, mais econômico 45,[47][48] e mais rápido comparado às radiografias, 45,48 que reduz a exposição à radiação, 45,47 e a ocorrência complicações associadas. [45][46] É um procedimento simples, mas que demanda habilidade do profissional.…”

Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study

“…In recent years, IC-ECG has been widely used for locating the ECC tip, especially in neonates. Growing evidence suggests that IC-ECG is a safe, accurate, easy, and immediate approach for intraoperative ECC tip confirmation [ 6 , 8 , 10 , 11 , 14 , 16 – 18 , 20 ]. To our knowledge, this retrospective analysis is the first study to quantitatively describe the major changes in IC-ECG for ECC via the lower extremity and determine its effectiveness and safety, which extends upon previous findings.…”

“…In this study, the ECC reference length was based on anatomical markers, while the actual insertion length was determined by IC-ECG, and the difference between the two was statistically significant ( P < 0.001). In neonates, increasing evidence has shown that IC-ECG-guided ECC placement can achieve more accurate tip positioning in the first attempt and reduce catheter-related complications [ 6 , 8 , 10 , 14 , 16 , 17 , 20 , 32 ]. Thus, it is necessary and valuable to use IC-ECG to locate the catheter tip during ECC catheterization.…”

“…Deeper on, a significant reduction in the P wave or a biphasic P wave indicates that the catheter has entered the right atrium. In recent years, IC-ECG has been widely used for ECC placement in neonates [ 6 , 8 , 10 , 11 , 14 , 16 – 18 , 20 ]. Because the majority of studies have suggested that the upper extremity was the preferred choice for neonatal catheterization, most studies on IC-ECG focused only on upper extremity ECC with the catheter tip in the SVC and excluded lower extremity ECC with the catheter tip in the inferior vena cava (IVC).…”