The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study

2018 ◽  
Vol 19 (6) ◽  
pp. 542-547 ◽  
Author(s):  
Antonella Capasso ◽  
Rossella Mastroianni ◽  
Annalisa Passariello ◽  
Marta Palma ◽  
Francesco Messina ◽  
...  
Keyword(s):  
Pilot Study ◽  
Superior Vena ◽  
False Negative ◽  
Vena Cava ◽  
P Wave ◽  
Target Zone ◽  
X Ray ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Head Neck

Purpose: The neonatologists of Sant’Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning. Patients and methods: We enrolled 39 neonates (1–28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head–neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates. Results: No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction–target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected. Conclusion: We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if “peak” P wave is detected.

Electrocardiogram (EKG) Guided Peripherally Inserted Central Catheter Placement and Tip Position: Results of a Trial to Replace Radiological Confirmation

2010 ◽  
Vol 15 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Nancy L. Moureau ◽  
Glenda L. Dennis ◽  
Elizabeth Ames ◽  
Robyn Severe
Keyword(s):  
Medical Center ◽  
Superior Vena ◽  
Vena Cava ◽  
Standard Of Care ◽  
P Wave ◽  
Current Standard ◽  
X Ray ◽  
Chest X Ray ◽  
Tip Position ◽  
Time Required

Abstract Background: The current standard of care for Peripherally Inserted Central Catheters (PICCs) is radiological confirmation of terminal tip location. Tip location practices in Europe have used electrocardiographic (EKG) guided positioning for central venous catheters for more than twenty years with tip positioning safely confirmed over thousands of insertions (Madias, 2003). The goal of this group was to confirm the findings of a study performed by Pittiruti and his team; and to establish safe function in the use of EKG guidance for verification of terminal tip position with PICCs placed at McKenzie Willamette Medical Center. Methods: In 2008/2009 McKenzie Willamette Medical Center conducted a study to determine whether or not EKG guidance can be used as a reliable means to accurately place and confirm terminal tip location of PICCs. A group of trained nurses performed PICC placement using EKG guidance followed by radiological confirmation of SVC position. All PICCs placed from October 2008 to December 2009 were included in the study. Tip location was confirmed using either radiological confirmation alone, EKG plus radiological confirmation, or EKG alone. Results: A total of 417 PICCs were placed during the study period. EKG guidance alone was used in the placement and confirmation of 168 PICCs. Both EKG and chest x-ray confirmation were used in the placement of 82 of the PICCs; 240 of the PICCs were placed with the use of EKG and then position correlated using the traditional chest x-ray procedure. Discussion: EKG guided PICC placement proved accurate in consistently guiding the terminal tip to the superior vena cava (SVC). The procedure was easily taught and duplicated by members of the PICC team. The study demonstrated a definite correlation between the height (size) of the P-wave and the location of the terminal tip within the SVC. With knowledge of this correlation, transition from placing PICCs using EKG guidance with chest x-ray confirmation to confirmation of tip placement using just EKG guidance without chest x-ray confirmation was attained. Application of EKG placement/confirmation performed during insertion saves time previously spent waiting for x-ray confirmation readings, saves cost of chest x-ray, prevents patient exposure to radiation and saves time required for tip repositioning of malpositioned tips found after the end of the procedure.

The EKG Method for Positioning the Tips of PICCs: Results from Two Preliminary Studies

2008 ◽  
Vol 13 (4) ◽  
pp. 179-186 ◽  
Author(s):  
Mauro Pittiruti ◽  
Giancarlo Scoppettuolo ◽  
Antonio La Greca ◽  
Alessandro Emoli ◽  
Alberto Brutti ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
X Ray ◽  
Non Invasive ◽  
Catheter Tip

Abstract Two preliminary studies were conducted to determine feasibility of using the electrocardiography (EKG) method to determine terminal tip location when inserting a peripherally inserted central catheter (PICC). This method uses the guidewire inside the catheter (or a column of saline contained in the catheter) as an intracavitary electrode. The EKG monitor is then connected to the intracavitary electrode. The reading on the EKG monitor reflects the closeness of the intracavitary electrode (the catheter tip) to the superior vena cava (SVC). The studies revealed that the EKG method was extremely precise; all tips placed using the EKG method and confirmed using x-ray were located in the superior vena cava. In conclusion, the EKG method has clear advantages in terms of accuracy, cost-effectiveness, and feasibility in conditions where x-ray control may be difficult or expensive to obtain. The method is quite simple, easy to learn and to teach, non-invasive, easy to reproduce, safe, and apt to minimize malpositions due to failure of entering the SVC.

Unusual malposition of a peripherally inserted central catheter into the left pericardiophrenic vein: A case report

2021 ◽  
pp. 112972982110189
Author(s):  
Alfonso Piano ◽  
Annamaria Carnicelli ◽  
Emanuele Gilardi ◽  
Nicola Bonadia ◽  
Kidane Wolde Sellasie ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Superior Vena ◽  
Vena Cava ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
X Ray ◽  
Bubble Test ◽  
Chest X Ray ◽  
The Right ◽  
Pericardiophrenic Vein

We report a case of primary malposition of a PICC inserted by guidewire replacement in the emergency room. Intraprocedural tip location by intracavitary electrocardiography was not feasible because the patient had atrial fibrillation; intraprocedural tip location by ultrasound (using the so-called “bubble test”) showed that the tip was not in the superior vena cava or in the right atrium. A post-procedural chest X-ray confirmed the malposition but could not precise the location of the tip. A CT scan (scheduled for other purposes) finally visualized the tip in a very unusual location, the left pericardiophrenic vein.

scholarly journals Ultrasonography Versus Chest X-Ray to Confirm Proper Placement of Central Venous Catheter

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Mehrnaz Nikouyeh ◽  
Kiandokht Khorshidi ◽  
Mohammad Hassan Rouzegari ◽  
Rabee Sarram
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Underlying Disease ◽  
Central Venous ◽  
X Ray ◽  
Comparison Results ◽  
Chest X Ray ◽  
The Right

Background: Central venous catheter (CVC) is located within the proximal third of the superior vena cava, inferior vena cava, or the right atrium. The confirmation of right location of catheter’s tip is done by chest X-ray (CXR) routinely. Objectives: In this study, we compared the proper location of the tip of the catheter by ultrasonography with CXR. Patients and Methods: One hundred and seventeen patients were included in this study. The CVC was placed according to the underlying disease. The proper location of the catheter was checked by ultrasonography and then CXR was carried out. The results of both methods were recorded and finally the statistical analysis was performed for comparison. Results: The tip of the catheter was observed by ultrasonography in 111 patients, but in the six other ones, the tip of the catheter was not observed by ultrasonography and observed in CXR. Therefore, the sensitivity of ultrasonography was 94.9 % in this study. Conclusion: The results showed that ultrasonography shows the catheter in 94.9% of the cases, although the risk of exposure to X-ray does not exist. The cost and time for evaluation of the tip of the catheter is significantly less by using ultrasonography compared to CXR.

scholarly journals Isolated Persistent Left Superior Vena Cava Revealed by an Associated Asthma

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
I. Bachouch ◽  
N. Belloumi ◽  
M. Attia ◽  
F. Chermiti Ben Abdallah ◽  
S. Hantous Zannad ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Corticosteroid Treatment ◽  
Inhaled Corticosteroid ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
X Ray ◽  
Chest X Ray ◽  
The Right

Background. Persistent left superior vena cava (PLSVC) is a rare anomaly of the thoracic venous system. Case Report. We present a case of a patient with isolated asymptomatic PLSVC, who was diagnosed because of dyspnea revealing an associated asthma. An 18-year-old male patient complained of paroxystic sibilant dyspnea. He did not have any anomaly in physical examination. The chest X-ray revealed cardiomegaly with a widening of lower mediastinum. The electrocardiogram does not show any anomaly. Echocardiography showed the PLSVC. The thoracic contrast computed tomography of the chest showed ecstasies of the right cardiac cavities and a double superior vena cava. The patient did not have similar family cases. Respiratory functional explorations led to the diagnosis of an associated asthma. Currently, he is followed up periodically. Asthma was improved with inhaled corticosteroid treatment. Conclusion. PLSVC is rare but can have important clinical implications. Associated severe cardiac malformations must be systematically sought.

Analysis of chest X-ray plain film images of intravenous ports inserted via the superior vena cava

Surgery Today ◽  
2014 ◽  
Vol 44 (8) ◽  
pp. 1513-1521 ◽  
Author(s):  
Jui-Ying Fu ◽  
Ching-Feng Wu ◽  
Po-Jen Ko ◽  
Ching-Yang Wu ◽  
Tsung-Chi Kao ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Plain Film ◽  
X Ray ◽  
Film Images ◽  
Chest X Ray

The diagnostic value of intracavitary electrocardiogram for verifying tip position of peripherally inserted central catheters in cancer patients: A retrospective multicenter study

2019 ◽  
Vol 20 (6) ◽  
pp. 636-645 ◽  
Author(s):  
Ting Yu ◽  
Ligui Wu ◽  
Ling Yuan ◽  
Robert Dawson ◽  
Rongmei Li ◽  
...  
Keyword(s):  
P Wave ◽  
Wave Surface ◽  
X Ray ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Tip Position ◽  
Surface Electrocardiogram ◽  
Central Catheters ◽  
Retrospective Multicenter Study

Purpose: To evaluate the feasibility and accuracy of intracavitary electrocardiogram for verifying tip position of peripherally inserted central catheters in cancer patients during follow-up period. Methods: From March 2015 to October 2015, 126 patients involved in eight hospitals who underwent peripherally inserted central catheter placement received intracavitary electrocardiogram and chest X-ray to verify position of the catheter tip during follow-up period. Their intracavitary electrocardiogram was compared with surface electrocardiogram to judge catheter tip landing zone in one of three different anatomical zones. The amplitude of intracavitary electrocardiogram P wave and the ratio of intracavitary electrocardiogram P wave/surface electrocardiogram P wave were measured and showed correlation with catheter tip position confirmed by chest X-ray. Based on chest X-ray principle, all the cases were assigned into three intracavitary electrocardiogram groups to explore the optimal cut-off values for intracavitary electrocardiogram P wave and intracavitary electrocardiogram P wave/surface electrocardiogram P wave by analyzing the receiver operating characteristic. Results: No technique-related complications or adverse events occurred in this study. The matching rate between intracavitary electrocardiogram and chest X-ray method was 93.7%. The optimal cut-off values for intracavitary electrocardiogram P wave were set from 3.15 to 3.75 mV, and intracavitary electrocardiogram P wave/surface electrocardiogram P wave from 1.65 to 3.25. Conclusions: It is demonstrated in this retrospective multicenter study that the intracavitary electrocardiogram method for verifying tip position of peripherally inserted central catheter during follow-up period is feasible and accurate in all adult patients with cancer.

Adolescent with facial swelling

2019 ◽  
pp. edpract-2019-317654
Author(s):  
Wen Shen Looi ◽  
Si Hui Goh ◽  
Colin Jingxian Tan ◽  
Kheng Wei Yeoh ◽  
Michaela Su-Fern Seng
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Vital Signs ◽  
List Type ◽  
X Ray ◽  
Normal Limits ◽  
Facial Swelling ◽  
The Face ◽  
Vena Cava Syndrome ◽  
Chest X Ray

BackgroundA previously well 15-year-old girl presented with a 2-month history of facial swelling that progressively worsened to involve the neck. There was associated dyspnoea, orthopnoea, headache and throat discomfort. Two weeks before presentation, the patient had an episode of fever for 5 days. On examination, vital signs were within normal limits. Swelling, plethora and venous distension of the face and neck were apparent (figure 1).Figure 1(A) Patient before the onset of symptoms. (B) Patient at presentation.QuestionsWhat is the most likely diagnosis?Superior vena cava syndromeAngioedemaAnasarcaDiphtheriaDescribe the chest X-ray (figure 2).What are the acute concerns?What investigations would you order?Figure 2Chest X-ray of the patient at presentation.Answers can be found on page 02.

Cephalad dislocation of PICCs under different upper limb positions: influence of age, gender, BMI, number of lumens

2018 ◽  
Vol 19 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Chie-Hee Cho ◽  
Peter Schlattmann ◽  
Sebastian Nagel ◽  
Nina Schmittbuttner ◽  
Frederic Hartung ◽  
...  
Keyword(s):  
Upper Limb ◽  
Superior Vena ◽  
Vena Cava ◽  
Upright Position ◽  
Basilic Vein ◽  
Position Change ◽  
X Ray ◽  
Vena Cava Superior ◽  
Chest X Ray ◽  
Multivariable Analyses

Purpose: To evaluate parameters that influence the amount of movement of peripherally inserted central catheter (PICC) tips regarding upper limb movement. Methods: In a prospective 12-month observational study, 200 PICCs were implanted in 162 patients (mean age 56.8 ± 15.2 years) by interventional radiologists into the basilic vein of the mid-aspect of the upper arm. Three PICC tip positions were documented with a chest x-ray: patient supine with an abducted (90°), an adducted arm, and in an upright position with an adducted arm. Multivariable analyses were performed, based on the three positions: body mass index (BMI), number of lumens, age, gender, side of the implantation, and brand. Results: Up to 88% of the PICCs dislocated in a mean of 19 mm cephalad when the patient was positioned from a supine in an upright position. The greatest influence upon dislocation was the position change from supine to upright. The side of the implanted PICC (left vs. right) had no influence. Conclusions: Cephalad dislocations of mean 19 mm regularly occur in the upright position induced by gravity. This needs to be taken in account and the PICC should be safely positioned one vertebra lower in the superior vena cava superior with a last confirmation of the PICC placement in an upright position.

Sign in / Sign up

Export Citation Format

Share Document