Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters☆☆☆
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.
Corresponding author. Division of Cardiology, University of Utah, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132-2401, USA.
☆ 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.
ABSTRACT