Intracavitary Electrocardiogram Research Articles

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.

Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram.

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.

Diagnosis of Arrhythmia for Patients with Occult Coronary Heart Disease Guided by Intracavitary Electrocardiogram under Data Mining Algorithm.

The objective of this study was to explore the application value of intracavitary electrocardiogram- (IEGM-) guided diagnosis of occult heart disease and conventional electrocardiogram (EGM) in the diagnosis of occult coronary heart disease (CHD) based on the classification and regression tree (CART) mining algorithm, hoping to provide a more effective basis for clinical diagnosis of the occult CHD. In this study, 100 patients with occult CHD admitted to our hospital from February 2016 to December 2020 were selected as the research objects. Based on the random number table method, 100 patients were randomly rolled into two groups, each with 50 cases. The patients diagnosed with conventional ECG were set as the control group, and patients in the experimental group were diagnosed with IEGM under the data mining algorithms. The diagnostic effects of the two groups were compared. The results showed that the processing effect of the CART algorithm (94%) was much better than that of the multiple linear regression algorithm (78%) and the random forest algorithm (69%) (P < 0.05), the agreement between the results of the experimental group and the results of coronary angiography (80%) and Kappa (0.7) was higher than those of the control group (55%, 0.45), and the difference was statistically significant (P < 0.05). In addition, the sensitivity (93%) and accuracy (80%) of the experimental group were obviously higher than those of the control group (62% and 55%), and the differences were remarkably significant (P < 0.05). In conclusion, the consistency ratio of the IEGM examination was higher, showing high accuracy; the intracavitary examination was invasive, so IEGM was not recommended when the diagnosis result of the examination may cause more harm than good.

Effects of indwelling centrally inserted central catheter on tip location of peripherally inserted central catheter with intracavitary electrocardiogram guidance: A retrospective case-control study.

Intracavity electrocardiogram (IC-ECG) guidance is an effective technology for monitoring the tip locations of centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs). However, for patients with an indwelling CICC, there has been no study on whether the CICC affects PICC tip positioning with IC-ECG guidance. Thirty people with a CICC requiring PICC insertion, matched with age to controls without a CICC. The stability of IC-ECG waveforms, the amplitude of P-waves, and the accuracy of PICC tip location were compared. There was no significant difference in the stability of the IC-ECG waveforms (χ2 = 0.22, p = 0.64). The amplitudes of baseline P-waves and ideal P-waves also showed no significant difference (t1 = 0.06, p1 = 0.96, t2 = 0.80, p2 = 0.43). Neither the accuracy of tip location (χ2 = 1.40, p = 0.50) nor the distance of PICC tip (t = -0.03, p = 0.98) were significantly different. For patients with an indwelling CICC, the position of PICC tip can be accurately determined by the dynamic changes in the P-wave amplitude.

RCT of Reduction in Catheter-Related Complications by Using Intracavitary Electrocardiogram-Assisted Guidance in Neonatal PICC Placement

To investigate the effect of intracavitary electrocardiogram (IC-ECG) guidance on peripherally inserted central catheter (PICC) related complications in neonatal patients. A total of 210 neonatal patients were included in the study. They were admitted to the Neonatal Intensive Care Unit, Sichuan Provincial People's Hosptial between January, 2017 and December, 2019 and had PICC lines were placed in their upper limbs. The patients were randomly assigned to the observation group, which had PICC placement through conventional anatomical landmark guidance combined with IC-ECG guidance ( n=105) or to the control group, which had PICC placement through only conventional anatomical landmark guidance ( n=105) for PICC catheter tip positioning. Patient baseline data and data on subsequent catheter-related complications of the two groups were collected and compared. There were no significant difference between the two groups in sex composition, gestational age, postnatal days on the day of PICC placement, duration of PICC placement, disease profile, and the site of puncture ( P>0.05). The observation group showed a significantly lower overall incidence of catheter-related complications (3.8%), compared to that of the control group (21.9%) ( P<0.05). The observation group showed significantly lower incidence of phlebitis and arrhthmia compared to that of the control group ( P<0.05). A combination of anatomical landmark guidance and IC-ECG guidance to assist the placement of PICC decreases catheter-related complications.

Diagnosis and management of secondary malposition of PICC into the azygos vein.

Peripherally inserted central catheter (PICC) has been widely used. The catheter-related complications might occur and the reports of secondary malposition into azygos veins were rare. This retrospective review summarized the experience in diagnosis and management of secondary malposition of PICC into azygos veins in 25 cases. When the catheter dysfunction occurred in the PICC on the left limb, it was necessary to consider whether there would be malposition into azygos veins after other reasons were excluded. The malposition could be diagnosed by chest lateral radiograph or chest computed tomography. The secondary malposition into azygos veins was resolved by repositioning or withdrawing the PICC. After re-inserting the catheter, it should be closely monitored whether the malposition occurred again. Intracavitary electrocardiogram positioning technology was used to confirm the catheter tip position before using corrosive drug. After the catheters withdrawn from the azygos veins, close attention should be paid to the property and concentration of the infusion drug strictly and the complications such as blockage and re-malposition. No serious complications such as infection, thrombosis and extravasation occurred in this group of patients after treatment. The results of our study suggested that the right limb is recommended for PICC catheterization in order to avoid secondary malposition into azygos veins and the malposition into azygos veins should be dealt with in time.

Use of intracavitary-ECG for tip location of femorally inserted central catheters.

Femorally inserted central catheters (FICCs) are frequently required for central access in children. Ultrasound can accurately locate the catheter tip in most cases and its use is increasing in clinical vascular access practice. In patients with poor acoustic windows, intracavitary electrocardiogram (IC-ECG) is an alternative to ultrasound-guidance for FICC positioning. A case series of three patients demonstrate methods of FICC positioning in children. The first patient had excellent acoustic windows and ultrasound-guided FICC positioning is described in conjunction with IC-ECG measurements. The following two patients had poor acoustic windows, thus IC-ECG guided FICC tip position. The use of FICCs in children has increased in recent years. Ultrasound has emerged as a reliable method of assessing FICC tip location. IC-ECG is an accurate and complementary method of assessing FICC tip location, but can be a primary method when ultrasound is not available or cannot directly visualize the catheter. IC-ECG P-wave characteristics identify optimal tip position at the inferior cavoatrial junction and are different from characteristics at the superior cavoatrial junction.

Evaluation of peripherally inserted central catheters (picc) for parenteral nutrition by intracavitary electrocardiogram verification method in our hospital setting.

Rationale: Total parenteral nutrition (TPN) requires the insertion of a central line catheter. There is an ultrasound-guided technique that uses the intracavitary ECG registry and allows to check the correct position of the catheter tip, without the need to irradiate the patient with chest radiography. To evaluate the applicability and the precision of the intracavitary ECG as a method of verifying the position of the PC in the PICC placed by the nursing team of Venous Routes of our center.

Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study.

Background: Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position.Objective: To investigate the causes and preventive measures of ECC-related PE in neonates.Methods: This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated.Results: ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero (P < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site (P < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without (P < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively.Conclusion: ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.

The application of intracavitary electrocardiogram for tip location of femoral vein catheters in chemotherapy patients with superior vena cava obstruction.

Most studies focused on the application of intracavitary electrocardiogram (IC-ECG) location in superior vena cava access catheterization, this study aimed to explore the effect of IC-ECG for tip location of femoral vein catheters in chemotherapy patients with superior vena cava obstruction (SVCO). A total of 158 patients placed catheters through superficial femoral vein from July 2016 to May 2019 were enrolled in the randomized controlled study. The patients were divided into two groups by envelope lottery method: X-ray location was used in the control group (n = 79); IC-ECG location was used in the observation group (n = 79). The catheters should be located at or near the inferior vena cava (IVC)-right atrium (RA) junction (above the level of diaphragm within the IVC). The general information of patients, clinical catheterization effects and catheter-related complications were compared between the groups. No significant differences in general information, catheter obstruction, catheter-related thrombosis, catheter exit-site bleeding and infection were found between the groups. The rate of successful insertion at the first attempt and patient satisfaction in the observation group were significantly higher than that in the control group (p < 0.05). The time and cost of location and the incidence of catheter-related complications in the control group were 32.57 min and 140.51 Yuan and 21.5%, which were significantly higher than 6.94 min and 13.59 Yuan and 7.6% in the observation group (p < 0.05). IC-ECG accurately located the tip of femoral vein catheters, reduced the incidence of catheter-related complications and the time and cost of location, improved patient satisfaction.

Randomized multicenter study on long-term complications of peripherally inserted central catheters positioned by electrocardiographic technique.

The intracavitary electrocardiogram (IC-ECG) method has been used for the tip location of central venous access devices for the advantage of being safe, accurate and highly cost effective. However, long-term follow-up is rare. This randomized clinical trial aimed to evaluate the long-term complications of peripherally inserted central catheters (PICCs) positioned by the IC-ECG method. We randomized 2250 patients who needed PICC placement to either a landmark length estimation supplemented by IC-ECG positioned group (ECG group) or the traditional landmark length estimation alone group (control group) in a 2:1 allocation. Post-procedural chest X-rays were applied to confirm tip position. Follow-up was performed monthly to six months. Standard statistics analyses were performed with the SAS 9.13 software, and p < 0.05 was considered significant. As evaluated by post-procedural chest X-ray, tip location in the ECG group had a first-attempt success (catheter tip located at optimal position) of 91.7% (95% confidence interval (CI): 90.3%-93.1%), significantly higher than 78.9% (95% CI: 76.0%-81.9%) observed in the control group (p < 0.001). At six-month follow-up, in the control group, frequency of total complications was 9.5%, including the exit site infection (4.0%), phlebitis (1.3%), deep venous thrombosis (1.5%), liquid extravasation (2.9%) and mechanical failure (1.9%). The IC-ECG group had significantly lower rates of complications (6.4%, p < 0.001), including the exit site infection (2.7%, p > 0.05), phlebitis (1.1%, p > 0.05), deep venous thrombosis (1.2%, p > 0.05), liquid extravasation (2.4%, p > 0.05) and mechanical failure (1.2%, p > 0.05). In the univariable logistic regression analysis, ECG method, other diseases and upper arms were the independent protective factors, and the number of adjustment procedures (n ≥ 2) were the independent risk factors of the complications. The intra-procedural tip location by IC-ECG is more safe and accurate than the traditional method of verifying tip location only post-procedurally, by chest X-ray.

Unique Cases of Intracavitary-Electrocardiogram Success in the Pediatric Intensive Care Unit: Jump Aboard, Innovators!

Highlights Abstract Proper peripherally inserted central catheter (PICC) placement has traditionally been confirmed by the use of a chest radiograph. With the innovation of the intracavitary electrocardiogram (IC-ECG), the use of a routine chest radiograph is not indicated. However, in many pediatric centers a chest radiograph is still required by policy. This article describes 4 cases in which PICC lines were properly placed using IC-ECG and the routine chest radiograph was unable to locate the PICC tip position.

Clinical application of intracavitary electrocardiogram in positioning of PICC catheter tip through inferior vena cava

Objective To explore the clinical application of intracavitary electrocardiogram in positioning of PICC catheter tip through inferior vena cava and summarize the change rule of electrocardiographic wave during the PICC process. Methods 60 patients who couldn′t receive PICC through precava were recruited from a tertiary hospital and assigned into the intervention group and the control group randomly. Patients in the control group received PICC through inferior vena cava and X-ray was used to confirm the positioning of PICC catheter tip. Patients in the intervention group were checked by intracavitary electrocardiogram. Success rates were compared and the change rule of electrocardiographic wave during the PICC process was summarized. Results The success rate was 100% in the intervention group and 86.7% in the control group. All patients in the intervention group showed the typical change of intracavitary electrocardiogram. Conclusions Intracavitary electrocardiogram can promote success rate of PICC through inferior vena cava and reduce the side effect. It is of great value to generalize intracavitary electrocardiogram in clinical application. Key words: Intracavitary electrocardiogram; PICC through inferior vena cava; Positioning of PICC catheter tip

Bedside temporary transvenous cardiac pacemaker placement

Temporary transvenous cardiac pacing is a life-saving procedure in an emergency. Transvenous cardiac pacing catheterization guided by intracavitary electrocardiogram (IC-ECG), instead of fluoroscope, is practical. Tips for controlling the orientation of the pacing catheter tip and utilizing IC-ECG to monitor the positions of electrodes make bedside temporary transvenous cardiac pacing catheter placement feasible and ‘visible’. The technique discussed here is comparable to the operation under fluoroscopy，but without exposure to X-ray.

Influence of arm position change from adduction to abduction on intracavitary electrocardiogram

The aim of this study is to evaluate the influence of arm movements from adduction to abduction on intracavitary electrocardiogram and the position of a catheter tip. Overall, 192 peripherally inserted central catheter lines were placed under intracavitary electrocardiogram guidance and 188 of them were enrolled in the study. The catheter was first placed at a time point corresponding to the peak P wave with the arm in adduction. The arm was then abducted to 90° without changing catheter insertion length. During the procedure, basal electrocardiogram, intracavitary electrocardiogram, and radiographs with the arm in adduction and abduction were recorded. Amplitude wave changes and catheter movements were measured on electrocardiogram records and radiographs, respectively. In 188 cases, the P wave displayed typical changes, and 97.8% (184/188) catheters were successfully placed correctly. At the peak P wave, the amplitude of the peak P wave was 8.64 times greater than that of the basal P wave, and the P/R ratio was 0.61. When the arm was abducted to 90°, the amplitude of the P wave dropped to 57% of its peak, P/R decreased from 0.61 to 0.34, and the catheter tip moved cephalad 1.00 and 0.77 vertebral body units in male and female patients, respectively. Peripherally inserted central catheter moves toward the heart when the arm position changes from abduction to adduction. Peripherally inserted central catheter tip placement at the peak P wave with patient's arm in adduction is accurate and can prevent the catheter from advancing too low. R wave can function as a reference for observing P wave changes during peripherally inserted central catheter placement.

Intracavitary electrocardiogram guidance for placement of peripherally inserted central catheters in premature infants.

This study evaluated the accuracy of intracavitary electrocardiogram (IC-ECG) guidance for placement of peripherally inserted central catheters (PICCs) in premature infants, relative to chest X-ray.Premature infants (n = 173) underwent placement of a PICC monitored by ECG, and a stable heart rhythm was shown. Changes in the P wave of the ECG reflected the position of the catheter tip, and a characterized P wave indicated the correct position. The P wave results were compared with a chest X-ray.P wave changes were observed in 157 (90.75%) of the premature infants on the ECG. Among them, the catheter tips of 148 (85.55%) and nine (5.20%) patients were in the correct and non-correct position, respectively, which was confirmed by chest X-ray. No characteristic P wave changes were observed in 16 (9.32%) patients on ECG, in which the catheter tips of eight (4.62%) patients each were in the correct and non-correct position, according to the chest X-ray. The accuracy of IC-ECG guidance for placement of the PICC was 90.17%. The PICC tip location results of the IC-ECGs were statistically similar to that of the chest X-rays.IC-ECG guidance is accurate for placement of PICC in premature infants, and provides an economical assessment without radiation.

Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study.

This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.

Work experiences of PICC nurse specialists in using intracavitary electrocardiography-guided PICC placement: a qualitative study

Objective To understand the work experience of PICC nurse specialists in using intracavitary electrocardiogram for PICC placement, so as to provide a reference for further promoting and standardizing of the intracavitary electrocardiogram method. Methods From October 2018 to February 2019, the PICC nurse specialists from 5 Class Two and 16 Class Three hospitals which developed intracavitary electrocardiogram guided PICC in Shandong Province were selected by purposive sampling method as interveiwees. A qualitative phenomenological study was used to conduct semi-structured interviews with 21 PICC specialist nurses. Colaizzi's seven-step analysis method was used to analyze the data. Results Three themes were identified: a method that makes your mind at rest, difficulties met in work, growth and learn. The intracavitary electrocardiogram method effectively promoted PICC placement and released pressure of nurse specialists. Nurse practitioners will experience hardship at the beginning of using the intracavitary electrocardiogram method. As they gradually became skilled and came across difficulties, they would experience development personally and professionally. Conclusions The intracavitary electrocardiogram method can benefit PICC nurse specialists both in their profession and career identity. However, the PICC nurse will face difficulties from different aspects while using this method. It is necessary to support better training courses and standardized management for the extension of intracavitary electrocardiogram method, promoting the promotion and application of new technologies. Key words: Electrocardiography; Nurse specialist; Qualitative study; PICC; Intracavitary electrocardiography

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

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.