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

Abstract

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.

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

“…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.…”

“…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 – 21 .…”

Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study

“…Therefore, our study might provide limited generalizability for the application of IC-ECG guidance for ECC placement via the lower extremity in preterm infants. Second, we chose CXR to confirm the tip position, which is a relatively inaccurate, post-procedural, time-consuming, and harmful methodology, whereas real-time ultrasound is an accurate, intra-procedural, real-time, non-invasive, and safe methodology [ 15 , 26 ]. Growing evidence suggests that real-time ultrasound is more accurate than conventional radiology because of its direct visualization of all venous districts and the catheter tip [ 26 , 40 , 41 ].…”

“…IC-ECG is a non-visual method for catheter tip location [ 15 ]. It is based on dynamic morphology changes of the P wave when the catheter tip is located in the superior vena cava (SVC).…”

ECG-Based Techniques to Optimize Peripherally Inserted Central Catheters: Rationale for Tip Positioning and Practical Use

“…In order to integrates the catheter moves between abduction and adduction Zhu et al (27) suggest to place the catheter with the peak P-wave with the arm in adduction.…”