Dataset Information

A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial.

ABSTRACT:

Background

The present study aimed to investigate the P-wave changes in intracavitary electrocardiography (IC-ECG) during catheterization with a peripherally inserted central catheter (PICC) in order to provide guidance for the accurate localization of the tip of the PICC.

Methods

A total of 106 newborns who needed a PICC were randomly divided into two groups-a study group and a control group-using a random number table, with 53 cases in each group. In the study group, the ECG monitor was connected after the successful puncture and insertion of the PICC into the right sternoclavicular joint, and the position of the catheter tip was determined according to the P-wave changes on the IC-ECG. Localization X-rays were taken at the same time. In the control group, after the successful routine puncture and insertion of the PICC into the location to a predetermined length, localization X-rays were taken. The accuracy, procedure duration, and cost of the two localization methods were evaluated.

Results

The accuracy of the localization in the study group was 92.5%, but the difference was not significant when compared with the control group (P>0.05). The duration of the procedure in the study group was 5.12±1.57 minutes, and the cost was 7.12±0.56 yuan, both of which were significantly different when compared with the control group (P<0.05).

Conclusions

P-wave changes during IC-ECG have high accuracy in determining the location of the tip of the PICC. It is also a simple method and has certain clinical application value.

Trial registration

Chinese Clinical Trial Registry (number: ChiCTR2100047660).

SUBMITTER: Zhu LB

PROVIDER: S-EPMC8578775 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial.

Zhu Li-Bo LB Liu Ling L Zhang Tie-Song TS Zheng Yu-Ting YT Lu Chun-Yan CY Lu Kun K Zhang Shu-Xian SX Duan Liu-Yan LY Yang Mei-Lin ML

Translational pediatrics 20211001 10

<h4>Background</h4>The present study aimed to investigate the P-wave changes in intracavitary electrocardiography (IC-ECG) during catheterization with a peripherally inserted central catheter (PICC) in order to provide guidance for the accurate localization of the tip of the PICC.<h4>Methods</h4>A total of 106 newborns who needed a PICC were randomly divided into two groups-a study group and a control group-using a random number table, with 53 cases in each group. In the study group, the ECG mon ...[more]

PMID: 34765464

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Project description:BackgroundThe placement of peripherally inserted central venous catheters (PICCs) has traditionally relied on measurements and anatomical landmarks. It involves post-placement chest X-rays (CXRs) and occasional repositioning, which incur additional direct and indirect costs, such as delays in care and staff time. The aim of this study was to assess the cost-effectiveness of a routine post-procedural CXR in the era of ultrasound and intracavitary electrocardiography (IC-ECG)-guided PICC insertion.MethodsA retrospective two-center study was conducted to review the clinical records of all patients who had PICCs in the Venous Access Center of Peking University Cancer Hospital & Institute and The Affiliated Qingdao Central Hospital of Qingdao University between 1 January 2019 and 30 June 2020. PICC placement was only available to patients who were 18 years or older, had in-sinus rhythm. The incidence of catheter misplacement after insertion was measured. Cavoatrial junction or the lower third of the superior vena cava (SVC) were defined as ideal catheter tip locations. A logistic regression analysis was performed to examine potential risk factors associated with PICC-related complications and a cost analysis was conducted to assess the economic impact of the use of CXR.ResultsThere were 2,863 samples from 2,653 patients included. The overall incidence of intraprocedural and primary catheter misplacement was 7.3% (n=210) and 0.70% (n=20), respectively. There was a high risk of primary catheter misplacement when the left-arm was chosen for placement [odds ratio (OR): 11.163; 95% confidence interval (CI): 3.720-33.495; P<0.001]. The overall cost of performing CXR for screening of PICC-related complications was $23,858 per year, and that of using CXR to diagnose 1 case of catheter misplacement was $1,789.ConclusionsThis study confirms that misplacement of PICCs guided by ultrasound and IC-ECG is rare and that postprocedural CXR is very costly. In our setting, routine postprocedural CXR is unnecessary especially when the PICC is catheterized in the right arm, and is not a wise option.

Project description:BackgroundCurrently, peripherally inserted central catheters (PICCs) are widely used; however, there are associated problems due to catheter-related thrombosis (CRT). According to the existing literature and guidelines, 3-6 months of anticoagulation therapy is recommended, but these recommendations are based on analogous deep vein thrombosis of the lower limbs. More specific management strategies need to be developed, and the safety and effectiveness of these strategies needs to be investigated.MethodsSome studies have suggested that catheter removal alone is a reasonable option, especially for patients with a higher risk of bleeding. We conducted a retrospective study of hospitalized patients from a single center who were diagnosed with PICC-related thrombosis. Among the 85 patients who met the inclusion criteria, 63 patients were treated with catheter removal alone, and 22 patients received anticoagulation therapy after catheter removal. The progression of thrombosis and bleeding in the two groups were compared. Most patients who underwent catheter removal alone had hematological malignancies, and thrombocytopenia had occurred during chemotherapy.ResultsAfter PICC removal, no patients in the anticoagulation therapy group developed progressive thrombosis, while 10 patients in the catheter removal alone group developed progressive thrombosis or pulmonary embolism (PE), including one case of PE, four cases of secondary upper extremity deep vein thrombosis (UEDVT), and five patients showed obvious aggravation of thrombosis after catheter removal, and were administered repeated anticoagulant therapy. In the PICC removal + anticoagulation treatment group, major bleeding increased significantly (28.6% vs. 4.7%, P=0.006).ConclusionsCompared to the PICC removal + anticoagulation treatment group, the risk of major bleeding in the catheter removal alone group was significantly reduced. In some patients with an increased bleeding risk, catheter removal alone may be a safer and more effective option than catheter removal with anticoagulation treatment for CRT.

Dataset Information

A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial.

Background

Methods

Results

Conclusions

Trial registration

Publications

A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial.

Similar Datasets

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