Intracavitary Electrocardiogram Research Articles

Optimal positioning of central venous catheters using intracavitary electrocardiogram: A narrative review

Central venous catheters (CVCs), either inserted centrally or peripherally (PICCs), are an essential therapeutic assist tool within and beyond critical care. The correct position of the tip of the CVC is important as suboptimal positioning may lead to complications. Chest X-ray remains the mainstay for tip position confirmation for the vast majority of CVCs. Intracavitary electrocardiogram (IC-ECG) is a validated method that can be utilized for this purpose. It is an accurate, easy-to-use, safer technique without radiation exposure. Its routine adoption in clinical practice is not universal. This narrative review discusses the techniques used for IC-ECG and their clinical implications.

Predictive model for totally implanted venous access ports‑related long‑term complications in patients with lung cancer.

Totally implanted venous access ports (TIVAPs), which are typically used in oncological chemotherapy and parenteral nutritional support, are convenient and safe, and thus offer patients a higher quality of life. However, insertion or removal of the device requires a minor surgical operation. Long-term complications (>30 days post insertion), such as catheter migration, catheter-related thrombosis and infection, are major reasons for TIVAP removal and are associated with a number of factors such as body mass index and hemoglobin count. Since management of complications is typically time-consuming and costly, a predictive model of such events may be of great value. Therefore, in the present study, a predictive model for long-term complications following TIVAP implantation in patients with lung cancer was developed. After excluding patients with a large amount of missing data, 902 patients admitted to The First Affiliated Hospital with Nanjing Medical University (Nanjing, China) were ultimately included in the present study. Of the included patients, 28 had complications, indicating an incidence rate of 3.1%. Patients were randomly divided into training and test cohorts (7:3), and three machine learning-based anomaly detection algorithms, namely, the Isolation Forest, one-class Support Vector Machines (one-class SVM) and Local Outlier Factor, were used to construct a model. The performance of the model was initially evaluated by the Matthew's correlation coefficient (MCC), area under curve (AUC) and accuracy. The one-class SVM model demonstrated the highest performance in classifying the risk of complications associated with the use of the intracavitary electrocardiogram method for TIVAP implantation in patients with lung cancer (MCC, 0.078; AUC, 0.62; accuracy, 66.0%). In conclusion, the predictive model developed in the present study may be used to improve the early detection of TIVAP-related complications in patients with lung cancer, which could lead to the conservation of medical resources and the promotion of medical advances.

Risk of deep venous thrombosis associated with peripherally inserted central catheter: A retrospective cohort study of 11.588 catheters in Brazil.

Deep Venous Thrombosis (DVT) due to Peripherally Inserted Central Catheter (PICC) is one of the most threatening complications after device insertion. To assess the rate of PICC-associated DVT and analyze the risk factors associated with this event in cancer and critically ill patients. We conducted a descriptive, retrospective cohort study with 11,588 PICCs from December 2014 to December 2019. Patients ≥ 18 years receiving a PICC were included. Pre-and post-puncture variables were collected and a logistic regression was used to identify the independent factors associated with the risk of DVT. The DVT prevalence was 1.8% (n = 213). The median length of PICC use was 15.3 days. The median age was 75 years (18; 107) and 52% were men, 53.5% were critically ill and 29.1% oncological patients. The most common indications for PICC's were intravenous antibiotics (79.1%). Notably, 91.5% of PICC showed a catheter-to-vein ratio of no more than 33%. The tip location method with intracavitary electrocardiogram was used in 43%. Most catheters (67.9%) were electively removed at the end of intravenous therapy. After adjusting for cancer profile ou chemotherapy, regression anaysis revealed that age (OR 1.011; 95% CI 1.002-1.020), previous DVT (OR 1.96; 95% CI 1.12-3.44) and obstruction of the device (OR 1.60; 95% CI 1.05-2.42) were independent factors associated with PICC-associated DVT, whereas the use of an anticoagulant regimen was a protective variable (OR 0.73; 95% CI 0.54-0.99). PICC is a safe and suitable intravenous device for medium and long-term therapy, with low rates of DVT even in a cohort of critically ill and cancer patients.

Systematic application of SICA-PED protocol for central venous catheterization in neonates: A prospective clinical study on 104 cases.

Catheterization of central vessels can be associated with early and late, potentially fatal complications. A proactive approach is imperative to reduce the frequency and magnitude of adverse events. Recently, the GAVeCeLT has proposed a protocol called SICA-PED (i.e. Safe Insertion of Central Access in Pediatric patients) and includes seven evidence-based strategies. Through a single-center prospective observational study, the authors wanted to consolidate the efficacy and safety of these protocol in newborns. In a series of 104 newborns, the seven steps of the protocol were applied (1) pre-procedural ultrasound study of the RaCeVA veins, (2) correct aseptic technique, (3) ultrasound-guided venipuncture, (4) intraprocedural localization of the tip of the catheter with TTE (ECHO TIP) and (iECG) intracavitary electrocardiogram, (5) reasoned choice of the implant exit site with the RAVESTO Tunneling technique, (6) anchoring without stitches, and (7) exit point protection with the use of glue and transparent semipermeable membrane. The authors have included a further precaution in point (6) the subcutaneous anchoring system has added the counter-fixation of the catheter wings that we will call 6Plus Point. All infants requiring implantation of elective us-guided central venous access were enrolled in the study. None of the 104 implanted central venous catheters experienced early complications (accidental arterial puncture, PNX, primary malposition); rare late complications such as ecchymosis, CRBSI, exit site infection or dislodgement were observed, No catheter-related thrombotic phenomena were observed. The CRBSI catheter-related infection rate was 2.47 × 1000 days catheter cases. The results of this prospective study strengthen the feasibility and efficacy of the SICA-Ped Protocol. Demonstrating that the systematic application of the evidence-based seven-step implantation strategy increases the success rate, minimizes early and late complications, which result in increased patient safety.

Effect of intracavitary electrocardiographic localization on the success rate and complications of PICC in infants.

Peripherally inserted central catheter (PICC) is widely used in chemotherapy of children with malignant tumors because of its safe operation and long indwelling time. To investigate the effect of intracavitary electroencephalogram (CEEG) localization technique on the success rate and complications of PICC in infants. A total of 180 children with PICC catheterization and maintenance at Shijiazhuang People's Hospital First Hospital from January 2017 to January 2020 were selected and divided into control group (n= 90 cases) and observation group (n= 90 cases). The control group observed the tip position of the fixed catheter through X-ray film and adjusted the catheter until its tip was located in the superior vena cava. The observation group used intracavitary electrocardiogram positioning technology. Comparison of the effects of two groups on the success rate and complications of PICC puncture in infants and young children. The success rate of one puncture in the observation group was significantly higher than that in the control group (P< 0.05). Within one month of catheterization, 13 cases had complications, with an incidence rate of 16.00% lower than the control group's 34.00% (27/80) (P< 0.05). The screening test results showed that the specificity, sensitivity, Youden index, accuracy, kappa coefficient, positive and negative predictive value were 88.89%, 97.56%, 0.86, 96.00%, 0.86, 0.86, respectively. The measured values were 97.56% and 88.89% respectively, and the cost and time of localization were lower than those of X-ray. The technique of intracavitary electrogram can be more accurate for infants to place the tip of central venous catheter through peripheral vein, which can effectively improve the success rate of one puncture with low cost, and has high reliability, accuracy and practicability, which is safe and effective.

Intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in a patient with persistent left superior vena cava: A case report.

Intracavitary electrocardiogram (IC-ECG) guidance is widely used for peripherally inserted central catheter (PICC) placement. The P wave variation has rarely been reported in persistent left superior vena cava (PLSVC). Here, we report a PLSVC case of P wave variation in PICC placement guided by IC-ECG. In this case, the P wave variation of the PLSVC was quite different from that of the right superior vena cava (RSVC). The tip of the catheter was located at the lower segment of the left superior vena cava according to postoperative radiography examination. PICC functioned normally, and no complications occurred.

Retracted: Intracavitary Electrocardiogram Guidance Aids Excavation of Rhythm Abnormalities in Patients with Occult Heart Disease

Retracted: Intracavitary Electrocardiogram Guidance Aids Excavation of Rhythm Abnormalities in Patients with Occult Heart Disease

Picc Line Associated Brachiocephalic Vein Rupture with Consequent Mediastinal Placement Causing Pneumomediastinum and Large Total Parenteral Nutrition Bilateral Effusion.

PICC lines, although seen as safer, have potential for catastrophic adverse effects.The use of intracavitary electrocardiogram may be a safe adjunct and even an alternative to the use of a chest X-ray.Aspirating blood from all lumens with particular emphasis on the distal most lumen is very important.

The effectiveness and feasibility of using multi-lead ECG monitoring combined with a programmed intracavitary ECG to complete left bundle branch area pacing.

Left bundle branch area pacing (LBBaP) as an alternative method for delivering physiological pacing, is difficult for many primary hospitals that lack the electrophysiological multichannel recorder to carry out. We hope to find a simple and feasible method that combines the multi-lead surface electrocardiogram (ECG) monitoring and the intracavity ECG of the pacing programmer to achieve LBBaP. A total of 50 patients with bradycardia indications who attempted permanent pacemaker implantation were included in this study. We referred to multi-lead surface ECG monitoring and pacing system analyzer (PSA), combined with the nine-zone pacing method of the LBBaP, to complete LBBaP. We assessed multiple parameters to verify whether the LBBaP was successfully achieved and used univariable analysis of variance for repeated measures to judge the feasibility and effectiveness of LBBaP without the electrophysiological multichannel recorder. LBBaP was successfully archived without the electrophysiological multichannel recorder in 44 of 50 patients (88%). In the study, paced QRS duration and the stimulus to peak left ventricular activation time (Sti-LVAT) were 117.04±10.34ms and 71.10±7.91ms and had no significant changes in the 3-month follow-up. The unipolar pacing threshold and R-wave amplitudes were 0.85±0.32V and 10.36±5.24mV at baseline respectively, which also showed stability during the 1-month and 3-month follow-up. During the 3-month follow-up, no lead-related complication was recorded. It is effective and feasible to achieve LBBaP combining the multi-lead ECG monitoring and the intracavitary ECG of PSA without the electrophysiological multichannel recorder, which could be an alternative to perform LBBaP.

A feasible and safe standardized protocol for ultrasound and intracavitary electrocardiogram-based tip navigation and tip location during placement of peripherally inserted central catheters.

Peripherally inserted central catheters (PICCs) are performed for medium and long term intravenous therapy. The most recent guidelines recommend the use of ultrasound-guided venipuncture to reduce surgery-related complications. In recent years, bedside ultrasound has also been used as evidence of accuracy in tip navigation and tip positioning. This paper is aimed to investigate using tip navigation with the ultrasonic technique and intracavitary electrocardiogram during the catheterization, and to suggest a feasible and safe standardized protocol for clinical practice. A total of 1727 tumor clients who suffered from combined the ultrasonic technique with intracavitary electrocardiogram (ECG + US group) to confirm the tip location of PICC were included in Peking Union Medical College Hospital in 2020. And based on electronic medical records according to the types of cancer as 1:1 to select 1727 cases who only underwent electrocardiogram (ECG group) to verify the tip location of catheters with the same team in 2019. Compared two groups of purpose of catheter, insertion site of upper limbs, times of puncture and delivery catheters, tip location and malposition of peripherally inserted central catheter, and analysis of the safety and feasibility. There were no significant differences between the two groups in the purpose of catheter, insertion site of upper limbs, times of puncture, and delivery catheters. The percentage of optimal tip location in ECG + US group was significantly higher than that in ECG group, and the rate of malposition of catheters was obviously lower than that in ECG group (p < 0.001). Tip navigation based with ultrasound and intracavitary electrocardiogram has high accuracy to confirm tip location of PICC, and it is also feasible and safe, which can not only to make up for the deficiency of patients without surface P waves who could not be applied ECG but also to fit for all patients.

Impact of peripherally inserted central venous catheter-associated phlebitis in neonate guided by intracavitary electrocardiogram: A systematic review and meta-analysis of randomised controlled trials.

Because the application of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) in the treatment of neonates is controversial in terms of phlebitis reduction compared with traditional X-ray positioning technique, a systematical evaluation is needed on the impact of IC-ECG on this common complication following PICC. Literature retrieval was conducted on large databases including PubMed, Google Scholar, Cochrane library, and CNKI. Randomised controlled trials (RTCs) of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in the treatment of neonates up to July 7, 2022, were collected. Then indicators of included studies were compared and analysed by two researchers. Meta-analysis was performed on the STATA 17.0 software. After excluding invalid trials, 11 out of 316 randomised controlled trials were included for further analysis. Meta-analysis results showed that compared with the control group, IC-ECG-guided PICC could decrease the incidence of phlebitis (I2 = 0.00%, P= 0.76, OR=0.33, 95% CI 0.19-0.56) and that no significant difference was observed between preterm neonates and term neonates (P= 0.74). Meanwhile, total complications were decreased in neonates (I2 = 0.00%, P= 0.00 OR=0.23, 95% CI 0.16-0.33). IC-ECG-guided PICC could also improve the accuracy of optimal tip location (I2 = 0.00%, P= 0.53, OR=5.37, 95% CI 3.80-7.59). IC-ECG-guided PICC could achieve reduced phlebitis incidence and total complications in the treatment of neonates, as well as increased accuracy of optimal tip location, no matter if those neonates were preterm or not. This study was registered in inplasy.com with No. INPLASY202280012 (DOI: 10.37766/inplasy2022.8.0012).

Application of intracavitary ECG for positioning the totally implantable venous access port in the upper arm of cancer patients.

Accurate positioning of the catheter tip is one of the most critical procedures in central venous catheter insertion. The traditional surface measurement method frequently has a large deviation and increases the X-ray exposure of doctors and patients. In the present retrospective study, cancer patients who received a totally implantable venous access port (TIVAP) in the upper arm using intracavitary electrocardiogram (ECG) guidance were compared with those where the traditional surface measurement method was used in terms of the rate of correct placement of the catheter tip, the rate of achieving the best position, the operation time and the complications. The results indicated that the correct placement rate and the best position rate of the catheter tip at the first attempt were higher in the ECG-guided group than in the traditional surface measurement method group (95.65 vs. 82.91% and 90.58 vs. 68.38%, respectively). The mean operation time was shorter in the ECG-guided group than in the surface measurement group (46.28 vs. 63.26 min). The incidence of complications in the ECG-guided group was 6.52%, while that in the surface measurement group was 10.26%. This indicated that the intracavitary ECG-guided tip positioning technique may improve the accuracy of tip catheter placement and shorten the operation time, thus reducing ionizing radiation caused by repeated positioning. Therefore, the intracavitary ECG-guided tip positioning technique is able to effectively place the tip of the TIVAD in the upper arm, holding great promise as a clinical application.

The positioning of the catheter tip with an intracavitary electrocardiogram in epicutaneo-caval catheter placement via lower limbs in newborns: A retrospective study.

Few studies have been conducted on whether catheterisation via the lower limb pathway is suitable for intracavitary electrocardiogram (ECG) technology. This study explored the positioning of the epicutaneo-caval catheter (ECC) tip with intracavitary ECG via the lower limbs in newborns to determine its optimal placement and to improve the success rate of ECC placement using this method. Twenty-eight cases were selected for the observation group. The tip location with intracavitary ECG method was used to observe the changes in specific atrial depolarisation (P-wave) during the catheterisation process to determine whether the catheter tip was in the correct position. For comparative observation, chest X-rays and abdominal radiographs were taken within 24 h to determine sensitivity and specificity. The control group included 28 cases where the ECCs were inserted via the lower limbs, and chest X-rays and abdominal radiographs were taken within 24 h after the line was placed to confirm the correct positioning. The success rate of the observation group was 91.30% (there were two cases of primary malposition), and the success rate of the control group was 78.57% (there were six cases of primary malposition). The success rate of the observation group was higher compared with the control group. The tip location with intracavitary ECG method improved the success rate of ECC placement via the lower limbs in neonates. This method can effectively prevent the occurrence of lower limb primary catheter malposition and has significant clinical application value.

Chest CT tomography vs. intracavitary electrocardiogram guidance in predicting the length of PICC placement

BackgroundTo evaluate chest computed tomography (CT) compared to intracavitary electrocardiogram (ECG) in predicting the length of peripherally inserted central catheter (PICC) placement and analyzing the accuracy of the positioning methods.MethodsThis study included a total number of 436 patients who underwent PICC placement. The patients enrolled were randomly divided into two groups: ECG group (n = 218, received IC-ECG) and chest CT group (n = 218, received chest CT). The tip length of the catheter in the superior vena cava, the measured length of the catheter and the actual insertion length of the catheter were observed and recorded in the two groups.ResultsThe best catheterization rate of tip positioning and the one-time placement rate of tip positioning in ECG group were significantly higher than that in the chest CT group (all P < 0.05). The comfort level and satisfaction rate in ECG group was significantly higher than that of chest CT group (all P < 0.05).ConclusionAccurate catheterization length could be achieved by both chest CT and intracavitary electrocardiogram guidance in the process of predicting PICC placement length. However, IC-ECG guided procedure was more worthy of promotion in clinic.

Clinical significance of intracavitary electrocardiographic localization in the prevention of PICC heterotopia in children with tumor.

ObjectiveTo explore the clinical significance of intracavitary electrocardiogram positioning technology in preventing catheter ectopic position during peripherally inserted central catheter (PICC) catheterization in children with tumors.MethodsA retrospective analysis of the clinical data of 62 children who required PICC catheterization was performed. The intracavitary electrocardiogram (ECG) positioning technology was used during the tube placement of the child patients. After the tube was successfully placed, the chest radiograph was taken. The ECG positioning result was compared with the chest radiograph positioning result after the tube was inserted, and the sensitivity and specificity of the ECG positioning were calculated.ResultsThe intracavitary electrocardiogram results of 62 children with PICC catheters showed that 56 cases (90.32%) had characteristic P waves, and six cases (9.68%) had no characteristic P waves. The chest radiographs of 56 children with characteristic P wave showed that 33 cases (58.93%) of the catheter tip position was appropriate, 22 cases (39.29%) of the catheter tip was too deep, and 1 case was in a non‐superior vena cava; six cases of chest radiographs of children with no characteristic P wave showed: one case was too deep at T8 level, one case was too shallow at T4 level, four cases were at non‐superior vena cava, one case was contralateral internal jugular vein, two cases in the contralateral brachiocephalic vein, and one case was the contralateral subclavian vein.ConclusionIntracavitary ECG positioning assisted catheter placement in infants can effectively improve the accuracy of catheter tip position.

Intracavitary electrocardiography for femorally inserted central catheter tip location in adult patients.

BackgroundIn this study, the intracavitary electrocardiogram (ECG) P‐wave and QRS‐wave changes during femorally inserted central catheter (FICC) placement in adults were observed with the aim of reducing malposition occurrence. The observed method provides venous access in patients who have limited upper limb venous catheterization potential and require medium‐term and long‐term infusions.MethodsA retrospective analysis of 34 adult patients who underwent FICC placement was conducted. After body surface measurements were taken, all patients were connected to an ECG during catheter placement, and the P‐wave and QRS‐wave changes were observed. Next, the catheter tip position was confirmed with an abdominal X‐ray, and an analysis of the changes occurring during the procedure was conducted.ResultsIn the 34 patients included in the present study, the catheter tips were located below the diaphragm level in the inferior vena cava. Of the patients, 18 showed negative P waves, biphasic P waves, and positive high‐amplitude P waves with increasing the insertion depth. In 16 patients, no P‐wave characteristic changes were observed during catheterization, and an abdominal X‐ray confirmed that the catheter tip was positioned below the level of the first lumbar vertebra.ConclusionNegative P waves, biphasic P waves, and positive high‐amplitude P waves appeared during FICC placement in adults. Catheter withdrawal until the P wave reverted to normal indicated that a tip position close to the inferior vena cava above the diaphragm level was ideal.

Application of intracavitary electrocardiogram classification in peripherally inserted central catheter localization in cancer patients

ObjectiveThis study aimed to analyze the application value of intracavitary electrocardiogram (ECG) classification in peripherally inserted central catheter (PICC) tip localization in patients with cancer. MethodsUsing a self-control study method, 325 patients with cancer underwent intracavitary ECGs to position the tip of a PICC catheter. The P wave, QRS wave amplitude, and waveform changes of each intracavitary ECG were recorded. Chest X-ray examination was performed after the catheterization to compare the results of different intracavity ECG maps with the results of the chest X-ray. ResultsThe intracavitary ECG positioning maps of the 325 patients were divided into four categories: (1) increased P wave (293 cases), accounting for 90.15% (293/325) of all cases; compared with the positioning results of the chest X-rays, the placement rate was 98.98% (290/293); (2) negative deepening of the P wave (1 case), accounting for 0.31% (1/325) of all cases and with a placement rate of 100% (1/1); (3) no change in P wave (19 cases), accounting for 5.85% (19/325) of all cases and with a placement rate of 42.11% (8/19); (4) atrial fibrillation/atrial flutter (12 cases), accounting for 3.69% (12/325) of all cases and with a placement rate of 58.33% (7/12). The four types of intracavitary ECG positioning maps had statistically significant differences (χ2 = 133.924, P = 0.000). ConclusionThere are four types of intracavitary ECG localization maps: increased P wave, negative deepening of the P wave, no change in P wave, and atrial fibrillation/atrial flutter. The increased P wave pattern had the highest occurrence probability and high positioning accuracy. It therefore has strong clinical application value for PICC tip localization in patients with cancer.

Clinical significance of different atlas of intracavitary electrocardiogram for PICC localization in 961 cases.

PurposeTo explore the application of ECG‐guided localization technology in PICC catheterization and the clinical significance of different maps of intracavitary ECG in PICC tip localization.MethodsIn the process of catheter placement under the guidance of ultrasound, the technique of intracavitary ECG location was used. The length of the catheter was measured on the body's surface. The amplitude of the P‐wave and the QRS‐wave groups of electrocardiograms before and during catheter placement was recorded. Nine hundred sixty‐one patients who underwent X‐ray chest film examination after catheterization were imaged on the chest film at the tip of the catheter.ResultsEight hundred four cases had a characteristic P wave, 83.66%, of which, 331 cases (50% < P/R ≤80%) had 99.09%; 425 cases (80% < P/R ≤100%) had 99.29%; 48 cases (P/R >100%) had 100%. One hundred eighteen cases of non‐specific P wave accounted for 12.28% and 79.66% of chest radiographs, of which 72 cases of P/R <50% were 100%; 46 cases of unchanged P wave were 47.83%; 34 cases of special cases accounted for 3.54% and 55.88% of chest radiographs; five cases of interference wave accounted for 0.25%, and the chest radiographs were self‐control. The in‐place rate of the body contrast catheter was 80%.ConclusionsThe accuracy of the ECG characteristic map in guiding the location of the PICC tip is higher than that of the non‐characteristic P wave, and it has more clinical significance in locating the best position of the PICC tip.

Intracavitary Electrocardiogram Guidance Aids Excavation of Rhythm Abnormalities in Patients with Occult Heart Disease.

In this paper, the analysis of intracavitary electrocardiograms is used to guide the mining of abnormal cardiac rhythms in patients with hidden heart disease, and the algorithm is improved to address the data imbalance problem existing in the abnormal electrocardiogram signals, and a weight-based automatic classification algorithm for deep convolutional neural network electrocardiogram signals is proposed. By preprocessing the electrocardiogram data from the MIT-BIH arrhythmia database, the experimental dataset training algorithm model is obtained, and the algorithm model is migrated into the project. In terms of system design and implementation, by comparing the advantages and disadvantages of the electrocardiogram monitoring system platform, the overall design of the system was carried out in terms of functional and performance requirements according to the system realization goal, and a mobile platform system capable of classifying common abnormal electrocardiogram signals was developed. The system is capable of long-term monitoring and can invoke the automatic classification algorithm model of electrocardiogram signals for analysis. In this paper, the functional logic test and performance test were conducted on the main functional modules of the system. The test results show that the system can run stably and monitor electrocardiogram signals for a long time and can correctly call the deep convolutional neural network-based automatic electrocardiogram signal classification algorithm to analyze the electrocardiogram signals and achieve the requirements of displaying the electrocardiogram signal waveform, analyzing the heartbeat type, and calculating the average heart rate, which achieves the goal of real-time continuous monitoring and analysis of the electrocardiogram signals.

A comparative study on the tip position of peripherally inserted central catheter inserted at two forward P-wave amplitudes by intracavitary electrocardiogram in cancer patients.

This study aimed to compare the tip location of peripherally inserted central catheter (PICC) under two forward P-wave amplitudes (P-wave amplitude is the autonomous peak or P-wave amplitude is 50-80% of the QRS main wave) by intracavitary electrocardiogram (IC-EKG) to determine the PICC tip in optimal location thus avoiding catheter-related complications. The data of 300 cancer patients with PICC insertion were collected retrospectively. For the observation group, the position of the catheter tip was left at the level when P wave amplitude was its autonomous peak (168 patients catheterized in 2018). While for the control group, the catheter tip was left at the level when the P wave amplitude was 50-80% of the QRS main wave (132 patients catheterized in 2017). Both groups of patients underwent the chest X-ray examination (CXR) after catheterization. The total compliance rate [PICC tip was located in the lower third of the Superior Vena Cava (SVC) and the Cavo-Atrial Junction (CAJ)], the optimal position compliance rate (PICC tip was located in the CAJ), and the incidence of the catheter tip malposition were compared between the two groups. The complications after catheterization including arrhythmia after catheterization within 24 hours, catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days were also compared. There was no difference in the total compliance rate of PICC tip position and the incidence of the catheter malposition in the two groups (P>0.05). But the optimal position compliance rate of the observation group was higher than that of the control group (P<0.05). There was no difference in the incidence of arrhythmia after catheterization within 24 hours of the two groups (P>0.05). The incidence of catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days in the observation group was lower than those in the control group (P<0.05). The PICC tip position at the autonomous peak of the P wave is significantly better than that at the P wave amplitude being 50-80% of the QRS main wave under the IC-EKG guidance for PICC insertion.