Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters.

BACKGROUND: Correct positioning of peripherally inserted central catheters (PICCs) is essential to avoid complications. We evaluated intravenous electrocardiogram (ECG) recordings during PICC placement to assess the effectiveness of this guidance technique to reduce complications resulting from incorrect catheter placement. METHODS: Six patients undergoing PowerPICC catheter insertion were included in this pilot study. Venography through the PICC was performed to identify the superior vena cava-right atrial (SVC-RA) junction. Unipolar ECG recordings from the catheter stylet measured P-wave changes during PICC insertion. RESULTS: The peak P-wave amplitude was highest at the SVC-RA junction. With catheter insertion into the RA, P-wave amplitude decreased and eventually became negative. With catheter withdrawal into the SVC, P-wave amplitude decreased. CONCLUSIONS: P-wave amplitude was highest when the PICC catheter was in the optimal location at the SVC-RA junction. Intravenous ECG monitoring during PICC insertion seems to be a promising technique to guide catheter positioning.

Acoustic cardiographic recording during ventricular fibrillation.

This is the second case report in literature that describes the simultaneous acoustic cardiographic, electrocardiographic, and invasive hemodynamic events that occurred before, during and after ventricular fibrillation that was successfully cardioverted to sinus rhythm. The absence of heart sounds, which are linked to the lack of effective myocardial contractility, correlated well with invasive hemodynamic data, indicating the lack of perfusion during ventricular fibrillation. These observations, coupled with the challenges of pulse detection as a sign of adequate perfusion during resuscitation suggest that acoustic cardiography may be a potentially effective supplemental diagnostic tool during the resuscitation of malignant arrhythmias.