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Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases

Received: 5 April 2019     Accepted: 11 May 2019     Published: 4 June 2019
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Abstract

A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants(207 male and 120 female)were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superficial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.

Published in American Journal of Nursing Science (Volume 8, Issue 4)
DOI 10.11648/j.ajns.20190804.13
Page(s) 142-144
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Intracavitary ECG, Malposition, PICC, Tip Placement, Premature Infants, Radiography

References
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[2] Oliver G, Jones M. ECG-based PICC tip verification system: an evaluation 5 years on. [J]. British Journal of Nursing, 2016, 25 (19): S4-S10.
[3] Walker G, Chan R J, Alexandrou E, et al. Effectiveness of electrocardiographic guidance in CVAD tip placement [J]. British Journal of Nursing, 2015, 24 (14): S4, S6, S8.
[4] Perin G, Scarpa M G. Defining central venous line position in children: tips for the tip [J]. Journal of Vascular Access, 2016, 16 (2): 0-0.
[5] Rossetti F, Pittiruti M, Lamperti M, et al. The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study. [J]. Journal of Vascular Access, 2014, 13 (3): 137-143.
[6] Neubauer A P. Central venous placement of silastic catheters by a recording of an intravascular ECG--a prospective study in 50 premature infants weighing less than 1000 g. [J]. Klinische Padiatrie, 1991, 203 (3): 146-148.
[7] Neubauer A P. Percutaneous central i.v. access in the neonate: experience with 535 silastic catheters [J]. Acta Paediatrica, 2010, 84 (7): 756-760.
[8] Weber F, Buitenhuis M, Lequin M H. Determination of the optimal length of insertion of central venous catheters in pediatric patients by endovascular ECG [J]. Minerva Anestesiologica, 2013, 79 (4): 379-84.
[9] Perin G. PICC placement in the neonate [J]. New England Journal of Medicine, 2014, 370 (22): 2153.
[10] Sharpe E, Kuhn L, Ratz D, et al. Neonatal Peripherally Inserted Central Catheter Practices and Providers: Results From the Neonatal PICC1 Survey [J]. Advances in Neonatal Care, 2016, 17: 1.
[11] Gemma O, Matt J. ECG or X-ray as the 'gold standard' for establishing PICC-tip location? [J]. British Journal of Nursing, 2014, 19: 10-6.
[12] Baldinelli F, Capozzoli G, Pedrazzoli R, Marzano N. Evaluation of the correct position of peripherally inserted central catheters: anatomical landmark vs. electrocardiographic technique [J]. Journal of Vascular Access, 2015; 16 (5): 394–398.
[13] Capasso A, Mastroianni R, Passariello A, et al. The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study [J]. The Journal of Vascular Access, 2018:112972981876129.
[14] Zhou L, Xu H, Liang J, et al. Effectiveness of Intracavitary Electrocardiogram Guidance in Peripherally Inserted Central Catheter Tip Placement in Neonates [J]. Journal of Perinatal & Neonatal Nursing, 2017, 31 (4).
[15] Zhou L, Xu H, Xu M, et al. An accuracy study of the Intracavitary Electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates [J]. Open Med, 2017, 12 (1): 125-130.
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  • APA Style

    Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang. (2019). Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. American Journal of Nursing Science, 8(4), 142-144. https://doi.org/10.11648/j.ajns.20190804.13

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    ACS Style

    Lilan He; Weiju Chen; Meng Zhang; Na Lin; Wenyan Yang. Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. Am. J. Nurs. Sci. 2019, 8(4), 142-144. doi: 10.11648/j.ajns.20190804.13

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    AMA Style

    Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang. Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. Am J Nurs Sci. 2019;8(4):142-144. doi: 10.11648/j.ajns.20190804.13

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  • @article{10.11648/j.ajns.20190804.13,
      author = {Lilan He and Weiju Chen and Meng Zhang and Na Lin and Wenyan Yang},
      title = {Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases},
      journal = {American Journal of Nursing Science},
      volume = {8},
      number = {4},
      pages = {142-144},
      doi = {10.11648/j.ajns.20190804.13},
      url = {https://doi.org/10.11648/j.ajns.20190804.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20190804.13},
      abstract = {A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants(207 male and 120 female)were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superficial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases
    AU  - Lilan He
    AU  - Weiju Chen
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    AU  - Na Lin
    AU  - Wenyan Yang
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    DO  - 10.11648/j.ajns.20190804.13
    T2  - American Journal of Nursing Science
    JF  - American Journal of Nursing Science
    JO  - American Journal of Nursing Science
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    EP  - 144
    PB  - Science Publishing Group
    SN  - 2328-5753
    UR  - https://doi.org/10.11648/j.ajns.20190804.13
    AB  - A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants(207 male and 120 female)were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superficial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.
    VL  - 8
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Author Information
  • Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

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