ABSTRACT
Objective To determine the accuracy of intracavitary electrocardiogram bimodal P-wave and characteristic P-wave in the position of PICC tip. Methods In the process of ECG guided catheterization, the morphological changes of P-wave in the intracavitary electrocardiogram were observed, and the bimodal P-wave and characteristic P-wave were recorded. The corresponding catheter length of the bimodal P-wave and characteristic P-wave were recorded. CT three-dimensional reconstruction was performed on 416 patients who underwent CT examination before and after catheterization. The distance between carina of trachea to superior vena cava and the right atrium junction was measured as best position of PICC and the standard distance. After catheterization, the distance from the tip of catheter to the corresponding catheter length of the bimodal P-wave and characteristic P-wave was measured as actual distance, and compared with the standard distance. Results In 416 cases, 168 patients (40.38％) were bimodal P-wave, and the accurate rate of bimodal P-wave was 86.31％(145/416), and the accurate rate of the characteristic P-wave was 13.69％(23/416). The standard distance was (41.96 ± 9.16) mm, the actual distance of corresponding characteristic P-wave was (48.00±15.18) mm and bimodal P-wave was (45.10± 11.16) mm. The distance of bimodal P-wave to control was (1.31±0.33) mm and characteristic P-wave was (6.00 ± 2.88) mm, which was significant statistical difference (t =5.197, P < 0.05), and the standard deviation of the distance of bimodal P-wave to control was smaller (0.33 < 2.88). Conclusions The intracavitary electrocardiogram bimodal P-wave is more accurate than characteristic P-wave in the position of PICC tip and it supplements and improves thePICC's tip position.
ABSTRACT
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.