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

Abstract

Background: 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.Methods: 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.Results: 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 catheterrelated thrombosis, catheter dysfunction, and catheter infection within 90 days in the observation group was lower than those in the control group (P<0.05). Conclusions: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.

Determination of optimal tip position of peripherally inserted central catheters using electrocardiography: a retrospective study

“…All rights reserved. of SVC (9.7% of patients) or in the RA (4.3% of patients) [11]. A retrospective study showed that only 56.1% of cases had catheter tips in the appropriate locations defined in Zones 2 and 3 of our study [33].…”

“…The absence of a typical biphasic P-wave can occur if the tip contacts the RA wall [ 16 , 30 ]. According to the study by Wang et al [ 11 ], the maximum P-wave amplitude can be obtained in the middle or upper 1/3 of SVC (9.7% of patients) or in the RA (4.3% of patients). A retrospective study showed that only 56.1% of cases had catheter tips in the appropriate locations defined in Zones 2 and 3 of our study [ 33 ].…”

“…A previous study reported that the most significant difference in the P-wave amplitude normalized to the R-wave was found at the CAJ (0.87 ± 0.14) [ 35 ]. The difference in P-wave/QRS complex ratio was also used for the PICC placement, and the ratio of 50–80% was regarded as CAJ [ 11 ]. However, the method using only the P-wave/QRS-complex ratio was not accurate enough because the final tip position was mainly located at the lower 1/3 of SVC rather than the CAJ [ 11 ].…”

“…The tipto-carina distance (TCD) was measured using an electronic caliper on CXR and calculated in vertebral body units (VBU), defined as the distance from the inferior endplate of the upper vertebra to the inferior endplate of the lower vertebra [10,[18][19][20]. The area from the CAJ to the lower 1/3 of the SVC was defined as the standard target location of the PICC tip, as reported in the previous studies [9][10][11].…”

“…The tip of a PICC or CVC should be placed in a large vein without contacting the vein or heart wall [ 6 ]. The recommended catheter tip location is between the lower 1/3 of the superior vena cava (SVC) and cavo-atrial junction (CAJ) [ 7 – 11 ]. If the tip is positioned above the recommended area, the risk of complication, such as catheter occlusion or infection, increases as blood flow decreases [ 6 , 9 , 12 ].…”