Abstract
Amplitude changes in the P-wave of intracavitary electrocardiography have been used to assess the tip placement of central venous catheters. The research assessed the sensitivity and specificity of this sign in comparison with standard radiographic techniques for tip location, focusing on factors influencing its clinical utility. Both intracavitary electrocardiography guided tip location and X-ray positioning were used to verify catheter tip locations in patients undergoing central venous catheter insertion. Intracavitary electrocardiograms from 1119 patients (of a total 1160 subjects) showed specific amplitude changes in the P-wave. As the results show, compared with X-ray positioning, the sensitivity of electrocardiography-guided tip location was 97.3%, with false negative rate of 2.7%; the specificity was 1, with false positive rate of zero. Univariate analyses indicated that features including age, gender, height, body weight, and heart rate have no statistically significant influence on P-wave amplitude changes (P>0.05). Multivariate logistic regression revealed that catheter insertion routes (OR = 2.280, P = 0.003) and basal P-wave amplitude (OR = 0.553, P = 0.003) have statistically significant impacts on P-wave amplitude changes. As a reliable indicator of tip location, amplitude change in the P-wave has proved of good sensitivity and excellent specificity, and the minor, zero, false positive rate supports the clinical utility of this technique in early recognition of malpositioned tips. A better sensitivity was achieved in placement of centrally inserted central catheters (CICCs) than that of peripherally inserted central catheters (PICCs). In clinical practice, a combination of intracavitary electrocardiography, ultrasonic inspection and the anthropometric measurement method would further improve the accuracy.
Highlights
Central venous access, including centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs) placement, is widely used in the clinical management of PLOS ONE | DOI:10.1371/journal.pone.0124846 April 27, 2015Intracavitary ECG in Central Venous Catheter Placement cancer patients, and is frequently a necessity for the delivery of chemotherapy, for surgical operations and for critical care
The final number of subjects achieving standards of enrollment were 1160, as 9 subjects withdrew from central venous catheters (CVC) insertion before the procedure, while 31 subjects were excluded for conditions list above
When the chest X-ray was used as the standard method for CVC tip location, the sensitivity of electrocardiography guided tip positioning accounted 97.3%; the specificity 1, with a false negative rate of 2.7% and a false positive rate of zero
Summary
Central venous access, including centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs) placement, is widely used in the clinical management of PLOS ONE | DOI:10.1371/journal.pone.0124846 April 27, 2015. The Infusion Nurses Society (INS) recommends a post-insertion chest X-ray to check the CVC tip position This technique, cannot be used to identify abnormal tip positions during the process of catheter insertion, and it is not always feasible, for patients who are in the immediate post-operative state, or in critical conditions. The changes in the P-wave are typically seen when the catheter tip reaches the superior vena cava at the right atrial junction [1,2,3]. We aimed to study P-wave changes during intracavitary electrocardiography guided tip location as well as to determine the factors that might influence them, so as to clarify the indications for this technique and to determine its clinical utility
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
