Accuracy and Safety Study of Intracavitary Electrocardiographic Guidance for Peripherally Inserted Central Catheter Placement in Neonates

Abstract

The purpose of this study is to investigate the accuracy and safety of intracavitary electrocardiogram (IC-ECG) guidance for the localization of peripherally inserted central catheter (PICC) in neonatal patients. A total of 160 neonatal patients were randomly assigned to receive either anthropometric measurement combined with IC-ECG guidance (n = 80) or conventional anatomical landmark guidance (n = 80) for PICC catheter tip positioning. The catheter tip position was confirmed by postinsertion radiograph and data were interpreted by independent radiologists. Subsequent catheter-related complications of neonates between 2 groups were also compared. The first-attempt target rate was 95.0% (95% confidence interval, 90.1%-99.9%) in IC-ECG–guided PICCs, significantly higher than 78.8% (95% confidence interval, 69.6%-87.9%) in the anatomical landmark guidance group (P < .05). In contrast, IC-ECG–guided PICCs provided a significantly lower overall incidence of the catheter-related complications (3.75%), compared with those guided by anatomical landmarks only (23.75%). Thus, combined use of anatomical landmark and IC-ECG guidance improved the first-attempt target rate of PICC placement and decreased catheter-related complications. These findings indicated a superior accuracy and safety of IC-ECG guidance to conventional anatomical landmark method in neonatal PICC practice.

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

“…IC-ECG had a high sensitivity and specificity (97.9 and 84.6%, respectively), and was helpful in clinical practice. Overall, IC-ECG is a safe, accurate, efficient, cost-effective, easy to use, and replicable way of correctly confirming ECC tip position ( 19 , 20 , 25 , 26 ). There was a significant difference in the catheterization site before and after implementation of IC-ECG ( P < 0.05).…”

The electrocardiographic method for positioning the tip of central venous access device

“…Krishnan et al 20 indicated that 22 patients (30.6%) had arrhythmia in landmarks-guided group during the procedure, compared to none in ECG-guided group. Ling et al 23 reported that ECG-guided group had a significantly lower overall complication (3.75%) than landmarksguided group (23.75%). Li et al 22 illustrated that the presence of thrombogenesis was significantly lower in the ECG-guided group at both 3 and 6 months after the procedure (p = 0.04 and p = 0.03, respectively).…”

“…After exclusion of duplicate references, non-relevant literature and those that did not satisfy inclusion criteria, 23 candidate articles were considered for the meta-analysis. After careful review of the full text of these articles, 13 studies [16][17][18][19][20][21][22][23][24][25][26][27][28] fulfilled the eligibility criteria. Details of the included studies were summarized in Table 1.…”

Variáveis associadas a eventos adversos em neonatos com cateter central de inserção periférica

“…Ante la complejidad de la atención médica que se presta a los recién nacidos gravemente enfermos, la terapia intravenosa, mediante un acceso venoso seguro, es un recurso primordial en los cuidados a esta población. Actualmente, el catéter venoso central de inserción periférica (Peripherally Inserted Central Venous Catheter, PICC) es una alternativa ampliamente utilizada para este fin por tratarse de un acceso estable, seguro y eficaz (1,2) .…”