Application of intracavitary electrocardiography in the insertion of the groshong peripherally inserted central catheters

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 X-ray 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. Key words: Intracavitary electrocardiogram; Peripherally inserted central catheters; Tip position