Abstract
A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants（207 male and 120 female）were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superficial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.
Highlights
Inserted central catheters (PICCs) are being placed routinely to provide nutrition and medications in neonatal intensive care units (NICUs), especially for preterm infants
From October 2015 to September 2018, intracavitary electrocardiography (IC-ECG)-guidance was applied in 327 preterm infants in our NICU
327 Peripherally inserted central catheters (PICCs) tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228(72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. 85 catheters went into an ideal position by withdrawing 0.5-2.5 cm
Summary
Inserted central catheters (PICCs) are being placed routinely to provide nutrition and medications in neonatal intensive care units (NICUs), especially for preterm infants. Some studys [1, 2, 3] have already demonstrated the safety and feasibility of IC-ECG in the positioning of central venous accesses in adult patients and children [4, 5] and have confirmed its accuracy compared with the postoperative chest X-ray. This method has been used in newborns: Neubauer [6, 7] reported the application of this technique in this particular patent population. We assessed the use of IC-ECG for determining PICC tip positions, compared with plain radiographs, in preterm infants in a tertiary NICU
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