P1.07-13 The Application of Intracavitary Electrocardiogram in the Femoral Vein Catheter Tip Location in Chemotherapy Patients with Lung Cancer

Abstract

For lung cancer patients with superior vena cava obstruction (SVCO), femoral vein PICC catheter at mid-thigh can be used to achieve chemotherapy. The X-ray, as the gold standard for catheter location, has some limitations such as long time-consuming and delayed in judgment. The intracavitary ECG location has been applied to the superior vena cava (SVC) catheter, which can make up for the shortcomings of X-ray. However, it is not clear whether it is suitable for inferior vena cava (IVC) catheter. Our research aim is to explore the clinical application value of intracavitary ECG location on femoral vein PICC at the mid-thigh. From January 2017 to December 2018, a total of 91 patients with SVCO, who were placed femoral vein PICC at the mid-thigh, were in enrolled. In the self-controlled study, catheter tip at the eighth to tenth thoracic vertebrae by X-ray location as the gold standard positive, and catheter tip at the position where the intracavity ECG occurred the first biphasic P wave and then receding 2 cm as the positive for the screening test. The study calculated the authenticity, reliability and practicality indicators of intracavitary ECG location. This study found the relationship between the position of the catheter tip and the P wave. When the tip of the catheter was in the IVC, most patients has negative P wave, and some patients has a low flat positive P wave. When the tip of the catheter entered the right atrium (RA), patients has biphasic P wave, and when the tip of the catheter entered the top of the RA, patients has huge biphasic P wave. In the study, the screening test was used to evaluate the accuracy and clinical application potential of intracavitary ECG in femoral vein PICC catheter tip location. In the authenticity index, the sensitivity was 98.73%, and the specificity was 91.67%. Yoden index was 0.90, the accuracy was 97.80%, the false positive rate was 8.33%, the false negative rate was 1.27%, the positive likelihood ratio was 11.85, and the negative likelihood ratio was 0.01. In the reliability index, the Kappa index value was 0.90. In the practical index, the positive predictive value was 98.73%, and the negative predictive value was 91.67%. Intracavitary ECG location can accurately locate the tip of the femoral vein PICC catheter at the mid-thigh. It has higher reliability and practicability, and has more great clinical application potential. It is worthy to clinical application.