Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases

Abstract

A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks' gestational age at PICC insertion was recorded. 327preterm infants(207 male and 120 female)were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superficial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.

The Effect of Modulating Environmental Stimuli on Pain Experience in Premature Infants During Peripherally Inserted Central Catheter-port Implantation

“…Premature infants experience several painful diagnostic or therapeutic procedures in the NICU, such as intravenous catheterization, venipuncture for blood sampling, gastric nasal tube insertion, endotracheal tube insertion, and peripherally inserted central catheters (PICCs). PICCs are being placed routinely to provide nutrition and medications in NICUs, especially for preterm infants [2][3][4]. Preterm infants are exposed to frequent painful procedures and agitating stimuli during the many weeks of their stay in the NICU [5].…”

“…A proper interpretation of pain-related behaviors in a preterm infant is crucial. PICC placement is a painful procedure and, like other painful procedures performed on infants, requires non-pharmacological and pharmacological methods to relieve the pain [3]. These methods are helpful, uncomplicated, and cost-effective.…”