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Objective To assess the application of intracavitary electrocardiography (IC-ECG) during the insertion of the Groshong peripherally inserted central catheters (PICC).Methods A total of 168 patients (aged 20-76 years) with gynecologic tumors who required the insertion of Groshong PICC because of various clinical conditions between January 2013 and December 2014 were selected into this study in Zhongnan Hospital of Wuhan University.During PICC insertion, the P-wave of IC-ECG helped general judgments about the position and direction of the tip of catheters, hence guiding the intubation.Precise position was determined by Xray following the fastening of catheters, based on which the accuracy and sensitivity of IC-ECG in the insertion of Groshong PICC were evaluated.Results All the cases presented typical changes of P-wave.However, 15 cases exhibited no such alternations in the first placement however deep or shallow the catheters were, in whom the typical P-wave was induced after withdrawal and replacement of the catheters with adjustment of patient position.According to the X-ray (gold standard), the accuracy and sensitivity of IC-ECG in diagnosing position of tip in the superior vena cava (SVC) were 98.8％ and 98.8％, respectively.The accuracy of diagnosing the position at the optimum location in the SVC reached 97.0％.Conclusions A high peaked P-wave of similar shape could be observed in IC-ECG in the insertion of Groshong PICC.IC-ECG could remarkably increase the positioning accuracy of PICC tip into the SVC;meanwhile, the optimal inserted length of the catheters could be determined by monitoring the changes of the P-wave with IC-ECG during insertion.
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Objective To explore the role of process management in preventing peripheral central venous catheter (PICC)-related bloodstream infections (CRBSI). Methods A standard process management policy was established for the uniform management of PICC in our hospital. The incidences of CRBSI before and after the implementation of this policy were compared. Results The incidences of CRBSI was 6.0‰ (48/79 793 ) every 1000 catheter-days before process management and 2.9‰ (29/99643) after process management (P =0.000).Conclusion Standard process management can effectively prevent and control CRBSI caused by PICC.
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Objective To compare the effectiveness and safety of central venous catheters inserted from the left side and right side during peripheral inserted central catheterizations (PICC). Methods Totally 458 adult patients undergoing PICC between May 2007 and May 2008 were enrolled in this study and divided randomly into right-sided group (n = 228)and left-slded group (n = 230). Chest X-ray was performed immediately after catheterization to identify the initial tip locations. Other parameters were evaluated during follow-up. Results The rate of difficult insertion was significantly lower in right-sided group than in left-sided group (14.9% vs 24. 8% , P =0.003). The rate of tip projection angle ＞40°was also significantly lower in right-sided group (2.2% vs 23.4% ,P = 0. 000). The rate of tips reaching the central veins was not significantly different between two groups (54.4%vs 53.0% , P = 0. 538). Compared with right-sided catheters, the tip positions in the left-sided group was significantly less frequently located in the inferior segment of superior vena cave in the central tip locations (6. 6% vs 21.0% , P =0. 001)and more commonly positioned in the nominate vein in non-central tip locations (66. 7% vs 48.1% , P = 0. 008). In addition, the catheter detaining time (P = 0. 617), incidence of local phlebitis after puncture (P = 0. 561), catheter obstruction rate (P = 0. 774), and catheter-related infection rate (P = 0. 854)showed no significant differences between two groups. The incidence of swollen limb was significantly lower inright-sided group than in left-sided group (4. 4% vs 8.3%, P = 0. 043). Conclusions Right-sided catheters provide better outcomes than left-sided catheters. PICC through the right elbow veins should be preferred in clinical practices.
ABSTRACT
Objective To analyze the changes of P wave of intracavitary electrocardiogram (ECC) in the placement of periph erally inserted central venous catheters (PICC), and to explore whether the intracavitary ECG can be used to guide the procedure. Methods PICC was inserted in 62 adult patients under intracavitary ECC-guided technique. The intracavitary ECC were recorded in different parts of vessel access through micro-guidewire. Results The intracavitary ECG extracted through micro-guidewire were accurately recorded in all patients. The amplitudes of P wave were (1.11 ±0.36)mm, (1.12±0.28)mm,(1.56±0.45)mm, (4.03±1.87)mm, (5.90±2.45)mm, (7.90±2.95)mm, (9.87±2.77)mm, (5.00±1.76)mm, (2.50±1.73)mm when PICC tip was located in the axillary, subclavian and brachiocephalic vein, in the superior, middle and inferior SVC, at the SVC-right atrium junction, and in the middle, inferior right atrium,respectively. The amplitude of P wave was 1.14±0.34mm in 10 patients with PICC tip malposition in the internal jugular vein. Conclusions The intracavitary ECG can be extracted with the microguidewire of PICC system. The amplitude of P wave is related to the location of PICC tip, which can be used to guide the PICC insertion and positioning.