The positioning of the catheter tip with an intracavitary electrocardiogram in epicutaneo–caval catheter placement via lower limbs in newborns: A retrospective study

Abstract

Objective: Few studies have been conducted on whether catheterisation via the lower limb pathway is suitable for intracavitary electrocardiogram (ECG) technology. This study explored the positioning of the epicutaneo–caval catheter (ECC) tip with intracavitary ECG via the lower limbs in newborns to determine its optimal placement and to improve the success rate of ECC placement using this method. Methods: Twenty-eight cases were selected for the observation group. The tip location with intracavitary ECG method was used to observe the changes in specific atrial depolarisation (P-wave) during the catheterisation process to determine whether the catheter tip was in the correct position. For comparative observation, chest X-rays and abdominal radiographs were taken within 24 h to determine sensitivity and specificity. The control group included 28 cases where the ECCs were inserted via the lower limbs, and chest X-rays and abdominal radiographs were taken within 24 h after the line was placed to confirm the correct positioning. Results: The success rate of the observation group was 91.30% (there were two cases of primary malposition), and the success rate of the control group was 78.57% (there were six cases of primary malposition). The success rate of the observation group was higher compared with the control group. Conclusion: The tip location with intracavitary ECG method improved the success rate of ECC placement via the lower limbs in neonates. This method can effectively prevent the occurrence of lower limb primary catheter malposition and has significant clinical application value.

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

“…In recent years, IC-ECG has been widely used for locating the ECC tip, especially in neonates. Growing evidence suggests that IC-ECG is a safe, accurate, easy, and immediate approach for intraoperative ECC tip confirmation [ 6 , 8 , 10 , 11 , 14 , 16 – 18 , 20 ]. To our knowledge, this retrospective analysis is the first study to quantitatively describe the major changes in IC-ECG for ECC via the lower extremity and determine its effectiveness and safety, which extends upon previous findings.…”

“…In this study, the ECC reference length was based on anatomical markers, while the actual insertion length was determined by IC-ECG, and the difference between the two was statistically significant ( P < 0.001). In neonates, increasing evidence has shown that IC-ECG-guided ECC placement can achieve more accurate tip positioning in the first attempt and reduce catheter-related complications [ 6 , 8 , 10 , 14 , 16 , 17 , 20 , 32 ]. Thus, it is necessary and valuable to use IC-ECG to locate the catheter tip during ECC catheterization.…”

“…The QRS amplitude increased continuously as the catheter deepens. Deeper on, an upright P wave was present, at this point the catheter was withdrawn until the P wave returned to normal, and the catheter was fixed at the inferior cavo-atrial junction where the QRS amplitude increased and the P wave remained normal [ 11 , 18 , 20 ].…”

“…Deeper on, a significant reduction in the P wave or a biphasic P wave indicates that the catheter has entered the right atrium. In recent years, IC-ECG has been widely used for ECC placement in neonates [ 6 , 8 , 10 , 11 , 14 , 16 – 18 , 20 ]. Because the majority of studies have suggested that the upper extremity was the preferred choice for neonatal catheterization, most studies on IC-ECG focused only on upper extremity ECC with the catheter tip in the SVC and excluded lower extremity ECC with the catheter tip in the inferior vena cava (IVC).…”

“…Nevertheless, evidence about the application of IC-ECG for lower extremity ECC is sparse. Only three studies reported the IC-ECG changes with the catheter tip located in the IVC [ 11 , 18 , 20 ]. When the tip is in the IVC, the QRS amplitude increases continuously as the catheter approaches the heart.…”