Intracavitary electrocardiography for femorally inserted central catheter tip location in adult patients

Aim: analyze the use of peripherally inserted central catheter in terms of the aspects of technique, positioning and maintenance, as well as the influence on the number of venous dissections in hospitalized infants in a neonatal unit. Method: descriptive, retrospective, quantitative study, in reference maternity unit of a city in northeastern Brazil. Sample composed of 1,599 peripherally inserted central catheter insertions in 1,204 infants during the years 2006 to 2013. Instruments were used that recorded aspects of the insertion of peripherally inserted central catheter and venous dissection. Results: most babies were premature, of low birth weight and male. The veins of the cubital region were the most punctured with insertion success until the fourth puncture. The central positioning of the catheter tip predominated, with a permanency time between 11 and 20 days, removing it at the end of the treatment. Over the years, the number of venous dissections was inversely proportional to the insertion of peripherally inserted central catheter. Conclusion: this transvenous device was shown to be important for the treatment of hospitalized newborns, favoring reduction of venous dissections.

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Methods for measuring venous peripherally inserted central catheters in newborns

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2021-0045 ◽

2022 ◽

Vol 75 (2) ◽

Author(s):

Andreia Tomazoni ◽

Patrícia Kuerten Rocha ◽

Mavilde da Luz Gonçalves Pedreira ◽

Elisa da Conceição Rodrigues ◽

Bruna Figueiredo Manzo ◽

...

Keyword(s):

Adverse Events ◽

Neonatal Intensive Care ◽

Descriptive Analysis ◽

Institutional Review Board ◽

Central Catheter ◽

Peripherally Inserted Central Catheters ◽

Institutional Review ◽

Significant Difference ◽

Catheter Tip ◽

Central Catheters

ABSTRACT Objective: to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. Methods: this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. Results: modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. Conclusions: between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.

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Electrocardiographic localization of peripherally inserted central catheter tip position in critically ill patients with advanced cancer: An application study

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12918 ◽

2021 ◽

Author(s):

Yong‐Hong Chai ◽

Su‐Ya Han ◽

Yu‐Xin Zhu ◽

Jin‐Jie Hou ◽

Xiao‐Hui Guan ◽

...

Keyword(s):

Critically Ill ◽

Advanced Cancer ◽

Critically Ill Patients ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Application Study ◽

Catheter Tip ◽

Tip Position

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Peripherally inserted central catheter tip position and risk of associated complications in neonates

Journal of Perinatology ◽

10.1038/jp.2012.112 ◽

2012 ◽

Vol 33 (4) ◽

pp. 307-312 ◽

Cited By ~ 39

Author(s):

A Jain ◽

P Deshpande ◽

P Shah

Keyword(s):

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Catheter Tip ◽

Tip Position

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Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

The Journal of Vascular Access ◽

10.1177/1129729820904833 ◽

2020 ◽

Vol 21 (5) ◽

pp. 732-737

Author(s):

Chunli Liu ◽

Dingbiao Jiang ◽

Tao Jin ◽

Chuanyin Chen ◽

Ruchun Shi ◽

...

Keyword(s):

Upright Position ◽

Body Posture ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Posture Change ◽

Body Change ◽

Catheter Tip ◽

The Mean ◽

Tip Position ◽

Chinese Cancer Patients

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p = 0.009) and height ( p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

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The Role of Saline Flush Injection Rate in Displacement of CT-Injectable Peripherally Inserted Central Catheter Tip During Power Injection of Contrast Material

American Journal of Roentgenology ◽

10.2214/ajr.13.10625 ◽

2014 ◽

Vol 202 (1) ◽

pp. W13-W18 ◽

Cited By ~ 4

Author(s):

Peter Morden ◽

Farnoosh Sokhandon ◽

Laura Miller ◽

Michael Savin ◽

Matthias Kirsch ◽

...

Keyword(s):

Contrast Material ◽

Injection Rate ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Power Injection ◽

Catheter Tip

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An accuracy study of the Intracavitary Electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates

Open Medicine ◽

10.1515/med-2017-0019 ◽

2017 ◽

Vol 12 (1) ◽

pp. 125-130 ◽

Cited By ~ 5

Author(s):

Lian-juan Zhou ◽

Hong-zhen Xu ◽

Mei-fang Xu ◽

Yan Hu ◽

Xiao-Fang Lou

Keyword(s):

Logistic Regression ◽

Lower Extremity ◽

Dynamic Change ◽

Multivariate Logistic Regression Analysis ◽

X Rays ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

P Waves ◽

Catheter Tip ◽

Accuracy Study

AbstractObjectiveTo explore the clinical application of the intracavitary electrocardiogram (IC-ECG) guided Peripherally Inserted Central Catheter (PICC) tip placement among neonates.Backgroundthe ECGs of neonates are difficult to perform and their wave shapes are of doubtful accuracy due to various interfering factorsMethod115 neonates were admitted to perform PICC guided by IC-ECG. Logistic regression was performed to analyze all possible influencing factors of the accuracy from the tip placement. The puncture site of the PICC, gestational age, height, weight, basal P/R amplitude and positioning P/R amplitude might be related to the accuracy of IC-ECG location.ResultThe accuracy in the lower extremity was higher than that in the upper extremity. Multivariate logistic regression analysis showed that the weight (Odds Ratio (OR)=1.93, 95%Confidence Interval(CI):1.06-3.50) and positioning P/R amplitude (OR=32.33, 95%CI: 2.02-517.41) are statistically significant risks to the accuracy PICC tip placement.ConclusionsPossible methods to improve the accuracy might be Catheterizing through lower extremity, keeping the neonates calm, enhancing the electrocardiogram signal and strengthening technical training. Therefore it is practical to perfrom a tip placement by the dynamic change in the P waves from an electrocardiogram (ECG) guided PICC among neonates and as reliable as using X-rays.

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Repositioning of malpositioned peripherally inserted central catheter lines with the use of intracavitary electrocardiogram: A pediatric case series

The Journal of Vascular Access ◽

10.1177/1129729819865812 ◽

2019 ◽

Vol 21 (2) ◽

pp. 259-264 ◽

Cited By ~ 3

Author(s):

Mark D Weber ◽

Adam S Himebauch ◽

Thomas Conlon

Keyword(s):

Superior Vena ◽

Vena Cava ◽

Case Series ◽

Right Atrial ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Case Presentation ◽

Central Lines ◽

Catheter Tip ◽

Standard Radiographs

Introduction: Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs. Case presentation: A case series of four patients will be discussed. The first three patients had peripherally inserted central catheter tips that were initially appropriately positioned but had later peripherally inserted central catheter tip migration. The use of intracavitary electrocardiogram was able to confirm the appropriate repositioning of the peripherally inserted central catheters without the need for serial radiographs. The fourth patient had several central lines in place, which led to difficulty in identifying the peripherally inserted central catheter tip location. The use of intracavitary electrocardiogram confirmed proper positioning of his peripherally inserted central catheter tip when standard radiographs could not provide clarity. Discussion: Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.

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