Journal of Electrocardiology
Volume 43, Issue 3 , Pages 274-278, May 2010

Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters☆☆☆

  • Brigham Smith, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
    • ,
  • Renée M. Neuharth, BS

      Affiliations

    • Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
    • ,
  • Mary Ann Hendrix, RN

      Affiliations

    • School of Nursing, University of Utah, Salt Lake City, UT, USA
    • ,
  • Daniel McDonnall, PhD

      Affiliations

    • Ripple, LLC, Salt Lake City, UT, USA
    • ,
  • Andrew D. Michaels, MD, MAS

      Affiliations

    • Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
    • Corresponding Author InformationCorresponding author. Division of Cardiology, University of Utah, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132-2401, USA.

Received 21 December 2009 published online 08 March 2010.

Abstract 

Background

Correct positioning of peripherally inserted central catheters (PICCs) is essential to avoid complications. We evaluated intravenous electrocardiogram (ECG) recordings during PICC placement to assess the effectiveness of this guidance technique to reduce complications resulting from incorrect catheter placement.

Methods

Six patients undergoing PowerPICC catheter insertion were included in this pilot study. Venography through the PICC was performed to identify the superior vena cava–right atrial (SVC-RA) junction. Unipolar ECG recordings from the catheter stylet measured P-wave changes during PICC insertion.

Results

The peak P-wave amplitude was highest at the SVC-RA junction. With catheter insertion into the RA, P-wave amplitude decreased and eventually became negative. With catheter withdrawal into the SVC, P-wave amplitude decreased.

Conclusions

P-wave amplitude was highest when the PICC catheter was in the optimal location at the SVC-RA junction. Intravenous ECG monitoring during PICC insertion seems to be a promising technique to guide catheter positioning.

Keywords: Peripherally inserted central catheter, Electrocardiography

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☆ This study was sponsored by Bard Medical, Inc (Covington, GA).

☆☆ This single-center study was sponsored by Bard Medical Inc (Covington, GA; ClinicalTrials.gov Identifier NCT00742053). The authors had complete access to data and performed the data analysis.

PII: S0022-0736(10)00085-3

doi:10.1016/j.jelectrocard.2010.02.003

Journal of Electrocardiology
Volume 43, Issue 3 , Pages 274-278, May 2010

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