The intracavitary electrocardiography method for tip location of jugular internal vein access device in infants of less than 5 kg: A pilot study

Purpose: This is a prospective observational study conducted by neonatologists in neonatal intensive care unit from Sant’Anna and San Sebastiano Hospital, Caserta, Italy. The objective of the study is to verify the feasibility of intracavitary electrocardiography method for tip location of central venous access device in infants of less than 5 kg and evaluate the accuracy of the method in comparison with post-procedural echocardiographical verification of the tip position. Patients and methods: We enrolled 27 patients weighted between 0.660 and 5 kg, requiring central vascular access. Ultrasound-guided jugular internal vein access was used and after cannulation, we applied the intracavitary electrocardiography for tip location as well as post-procedural echocardiography. Results: No significant complication related to intracavitary electrocardiography occurred in the studied infants. The increase in P wave on intracavitary electrocardiography was detected in all cases (27/27). In only one case (false positive), the catheter had the tip out of cavoatrial junction–target zone (to post-procedural echocardiography). Conclusion: The intracavitary electrocardiography method for tip location of central venous access device is safe and accurate in infants, as demonstrated by post-procedural comparative echocardiographic controls. As an alternative to echocardiography, not always achievable, the diffusion of intracavitary electrocardiography method could reduce X-ray exposition and complications of a malpositioned tip.