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Objective:To investigate the feasibility of using body surface marker localization method to determine the correct position of catheter tip (lower 1/3 of the superior vena cava or the junction of superior vena cava and right atrium) in totally implantable venous access port (TIVAP) implantation via internal jugular vein approach.Methods:The clinical data of 220 patients who underwent TIVAP implantation in Beijing Tongren Hospital, Capital Medical University from June 2019 to June 2021 were retrospectively analyzed. Among them, 168 patients used the internal jugular vein approach. According to the method implemented for determining the length of central venous catheter (CVC) during the operation, the patients were divided into two groups: 136 patients using the body surface marker localization method were defined as the study group; and the remaining 32 cases treated by the intraoperative X-ray fluoroscopic localization method were defined as the control group. The difference in the excellent or good rate of CVC tip position immediately after implantation and the time of implantation was compared between the two groups. In addition, the correlation between the length of CVC indwelling, height, age, and the distance between the catheter tip and tracheal carina was analyzed for the patients with right and left internal jugular vein catheterization. Kolmogorov-Smirnov test was used for statistical distribution of measurement data. Normal distribution of measurement data was expressed as mean ± standard deviation ( ± s), independent sample t-test was used for comparison between groups. Chi-square test was used for comparison between counting data. With TIVAP catheter indenture length as dependent variable and height as independent variable, Pearson correlation analysis was performed, the relationship equation between ideal catheter indenture length and patient height was analyzed by unitary linear regression. Results:When the CVC tip was located at the second intercostal space, the third sternocostal joint and the third intercostal space, the corresponding probability of being in the correct position was 34.8%, 83.3% and 95.0% respectively. The third sternocostal joint or the third intercostal space had a higher probability of correct CVC tip location than the second intercostal space, and the difference were statistically significant ( P<0.001). Furthermore, there was no significant difference in the possibility of the CVC tip located in the correct position between the third sternocostal joint and the third intercostal space ( P=0.149). Compared with the control group (before adjusting catheter position), the proportion of excellent or good CVC position in the study group was significantly improved (94.1% vs 46.9%), and the difference was statistically significant ( χ2=41.99, P<0.001); while the total operation time was significantly shortened [(33.04±6.69) min vs (42.50±5.54) min], and the difference was statistically significant ( P<0.05). There was a linear correlation between the length of CVC insertion and height. Indwelling catheter length via right internal jugular vein approach (cm) =0.159× height (cm)-1.284 ( r=0.597, r2=0.356, P<0.001); length of catheter indwelling through the left approach (cm) =0.097× height (cm) + 12.139 ( r=0.322, r2=0.104, P=0.020). Conclusions:The third sternocostal joint or the third intercostal space would be the corresponding correct surface landmark of the CVC tip when the body surface marker localization method was adopted during the TIVAP implantation via the internal jugular vein approach. Compared with the intraoperative X-ray fluoroscopy localization, the operation time is significantly shortened with the application of the body surface marker localization method. This technique is simple and easy to master and has high reliability in determining the length of catheter and the position of CVC tip.
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The best tip position of PICC is located in the inferior 1/3 of superior vena cava to the junction between superior vena cava and right atrium. Ensuring the best tip position of PICC is very important for the treatment of patients. In this paper, the applications of X-ray positioning, electrocardiograph, ultrasound, electrocardiograph Doppler ultrasound guidance, and electromagnetic navigation system in PICC tip positioning technology are reviewed. The future development of PICC tip positioning technology is prospected.
Subject(s)
Humans , Catheterization, Central Venous , Central Venous Catheters , Electrocardiography , Heart Atria , Ultrasonography, Doppler , Vena Cava, Superior , X-RaysABSTRACT
Objective To investigate the accuracy and safety of using normal saline as a medium to guide the catheter lumen to assist the localization of the catheter tip. Methods This study included the patients with hematological malignancies in our fully implantable venous port. We enrolled 105 patients from January 2014 to December 2015 as control group, and 220 patients from January 2016 to June 2017 as the experimental group. The control group used the traditional fully implantable venous port after the chest X slice to determine the location of the catheter tip. The experimental group used the intracavitary electrocardiogram location technology to assist the complete implantable venous port catheter tip positioning catheter, then chest X film. Results No catheterization occurred in all the patients. The rate of catheter placement was 100％. In the experimental group, 179 patients (81.36％) had the best placement of catheter tip (i.e., superior vena cava right atrium junction, CAJ), and 35 patients (52.38％) in the control group had the best placement of catheter tip. The proportion of the catheter tip located in the best position (the superior vena cava auricular commissure and CAJ) in the experimental group was higher than that in the control group (χ2=29.615, P < 0.05). Conclusions By the injection of saline guided endocardial mapping real-time monitoring of totally implantable venous transfusion port catheter tip position, can guide the surgeon to grasp the real-time operational direction of totally implantable venous transfusion port catheter tip, accurately positioning the catheter tip position, improve the surgical success rate, worthy of clinical use.
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Objective To evaluate ECG-aided tip localization of peripherally inserted central catheter(PICC),and to explore the predictive value of in vitro measurement length to optimal length.Methods Convenience sampling method was used to recruit 743 patients from 18 tertiary hospitals in 11 provinces.Patients received ECG-aided tip localization during PICC placement.After PICC was inserted,orthophoria chest radiograph (OCR) was conducted to check whether the tip position of PICC was appropriate.Results Totally 624 valid questionnaires were collected.OCR showed that all tips of PICCs were located in the optimal position.The optimal length was positively correlated with in vitro measurement length (r=0.920,P＜0.01).Linear regression showed regression equation was Y(the optimal length inserted through left basilic vein)=4.290+0.897X(in vitro measurement length)(R2=0.834,F=942.459,P＜0.001),and Y(the optimal length inserted through right basilic vein)=3.097+0.922X(in vitro measurement length)(R2=0.855,F=2055,P＜0.001).Conclusion Change of P-wave can be used to guide PICC placement and predict tip location.ECG-aided tip localization of PICC is accurate,and can be used as an alternative way.Besides,regression equation can be used to predict the optimal length of PICC.
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Objective The intracardiac electrocardiogram (ecg) positioning technology in the clinical appli -cation of PICC catheter tip to locate effect were discussed .Methods 115 cases of our department in October 2013-2014 December PICC placement of patients admitted to the study .All patients completed according to uniform pro -cedures catheter, and the use of intracardiac electrocardiogram positioning technology in the catheterization process PICC catheter tip positioning, again catheter positioning X -ray film.Results Intracardiac electrocardiogram PICC tip into the superior vena cava sensitivity of 93.03%, and the situation is a total of seven cases no P wave changes , the rest of the patient P or T wave changes .X -ray showed 108 cases of catheter tip is located on the within the vena cava, and two cases in the subclavian vein (intravenously to two cases of circular motion , resulting in a circular mo-tion intravenous catheter insufficient length , which does not reach the superior vena cava ), and two cases in the inter-nal jugular vein, three cases in the brachial vein .Conclusion PICC catheter tip positioning taking intracardiac elec -trocardiogram positioning technology , with high sensitivity and specificity , which can be clinical application .