Immediate post‐insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration

Carvalho, Bruno R De; Eagar, Gerard M

doi:10.1111/1754-9485.12698

Cited by 11 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 97%

“…The chest X-ray examination indicated that the catheter tip was not at the optimal position in 14 patients. This may be that the body position was not consistent between the chest X-ray examination and IC-ECG localization [19][20][21] . The 5.45% and 10% sodium chloride solutions were superior to the 0.9% sodium chloride solution in the derived rate of stable IC-ECG, occurrence rate of characteristic P wave and time used for catheter tip localization, so high-concentration sodium chloride solutions (5.45% or 10%) were the first choice for the ECG-guided arm infusion port implantation.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Effects of different concentrations of intraluminal sodium chloride solution on intracavitary ECG used for arm infusion port implantation

Dong

Guan

Zhang

et al. 2022

Sci Rep

View full text Add to dashboard Cite

At present, there are few clinical studies on the application of high-concentration sodium chloride solutions in intracavitary ECG-guided catheter tip localization during the arm infusion port implantation. This study observed the effects of sodium chloride solutions with different concentrations on intracavitary ECG-guided arm infusion port implantation in the patients with cancer. The 657 patients receiving arm infusion port implantation in our hospital between January 2020 and August 2021 were randomly divided into 0.9% sodium chloride solution conduction group (group A), 5.45% sodium chloride solution conduction group (group B) and 10% sodium chloride solution conduction group (group C). The derived rate of stable intracavitary ECG, the occurrence rate of characteristic P wave, the time used for catheter tip localization and the optimal position rate of catheter tip were compared between the three groups. The derived rate of stable intracavitary ECG was significantly higher in the group B (97.78%) and group C (98.63%) than in the group A (93.90%) (all P < 0.05). The occurrence rate of characteristic P wave was also significantly higher in the group B (96.89%) and group C (97.72%) than in the group A (88.73%) (all P < 0.001). The time used for catheter tip localization was significantly shorter in the group B [(49.73 ± 8.15) s] and group C [(48.27 ± 8.61) s] than in the group A [(69.37 ± 19.99) s] (all P < 0.001). There was no significant difference in the optimal position rate of catheter tip among the three groups (P > 0.05). The 5.45% and 10% sodium chloride solutions are significantly superior comparing with 0.9% sodium chloride solution in the derived rate of stable intracavitary ECG, occurrence rate of characteristic P wave and time used for catheter tip localization, but there were no significant differences between 5.45 and 10% sodium chloride solutions. Moreover, the 5.45% sodium chloride solution is closer to physiological state comparing with 10% sodium chloride solution, so the 5.45% sodium chloride solution may be recommended for the intracavitary ECG-guided arm infusion port implantation.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Effects of different concentrations of intraluminal sodium chloride solution on intracavitary ECG used for arm infusion port implantation

Dong

Guan

Zhang

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…21 Furthermore, in the inspiratory state, compared with the expiratory state, the catheter tip position moves about 1 cm. 24 Therefore, we speculated that the reasons for the difference in tip position between the two methods may be related to the following factors, the patients insertion routes, wire diameter and junction surface, the P-wave amplitude changes are more easily found in a short insertion route and big guidewire diameter. 25,26 In this study, there are some limitations: (1) the ECG technique is not applicable for FA or similar patients with no P-wave; (2) the ECG technique is a simply tip location technique, magnetic or ultrasound combined with ECG technique such as Sherlock 3CG technique is more efficient in reducing risks for primary malposition in the tip location; (3) the sample size was small, more extensive samples are needed in the future study.…”

Section: Discussionmentioning

confidence: 99%

“…When the arm changes from abduction 90°to adduction, the position of the catheter tip will move toward to the atrium, meanwhile when the patient changes from the supine position to the upright, the position of the catheter tip has a tendency to move toward to the SVC, The mismatch between intra‐procedural ECG method and post‐procedural CXR was significantly lower when the X‐ray was taken in supine position 21 . Furthermore, in the inspiratory state, compared with the expiratory state, the catheter tip position moves about 1 cm 24 . Therefore, we speculated that the reasons for the difference in tip position between the two methods may be related to the following factors, the patients were in supine position with arm abduction 90°during the port placement, but the patients were in upright position with arm adduction during the CXR after the port placement, as well as the influence of respiratory movement.…”

Section: Discussionmentioning

confidence: 99%

Guidewire‐guided electrocardiogram for positioning the catheter tip of upper arm port in breast cancer patients

Meng

et al. 2021

Precision Medical Sciences

View full text Add to dashboard Cite

Intracavitary electrocardiogram (ECG) is a reliable and safe method for real-time, confirming the tip of central venous access devices. Saline and guidewire are the most commonly used as an intracavitary electrode for introducing ECGs. However, little information about the ECG technique using for the catheter tip of arm port. We aimed to explore the effects of guidewire-guided ECG approach for locating the catheter tip of the upper arm port in breast cancer patients. We performed a prospective single-center study, 36 patients with breast cancer were enrolled. Thirty-six upper arm ports were implanted using a guidewire guided ECG approach, to evaluate the accuracy of the catheter tip position, the operation time, and the stability of the ECG waveform. The ECG-based tip location was compared with post-procedural tip location by chest X-ray. We found that all the upper arm ports implantation were successful in this study. The tip was located at the lower 1/3 superior vena cava or cava-atrial junction in 35 cases and the upper right atrium in one case. The average operation time of the ECG was 269.25 ± 52.79 second, (range: 190-345 seconds). The correct rate of the catheter tip position was 97.22%. All the ECG waveform was stable and easy to read. In conclusion, the guidewire-guided ECG technique is valid and accurate for locating the upper arm port catheter tip; it is also convenient.

show abstract

“…All catheters were placed, and its tip was confirmed by IC-ECG in a supine position with the arm in abduction, as some other studies had reported catheter advancement toward the right atrium because patient's arm moved from abduction to adduction. 10,14 However, there is a lack of studies on the effect of arm position changes on IC-ECG and the further decision of where to leave the catheter. In this study, we aimed to determine the influence of arm position change from abduction to adduction on its IC-ECG as the catheter reached the CAJ to provide substantial initial Chinese patient data with which to improve PICC technique for local use.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.

show abstract

Immediate post‐insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration

Cited by 11 publications

References 19 publications

Effects of different concentrations of intraluminal sodium chloride solution on intracavitary ECG used for arm infusion port implantation

Effects of different concentrations of intraluminal sodium chloride solution on intracavitary ECG used for arm infusion port implantation

Guidewire‐guided electrocardiogram for positioning the catheter tip of upper arm port in breast cancer patients

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

Contact Info

Product

Resources

About