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"The use of an ECG to localize the PICC tip in critically ill patients with advanced cancer may replace the unnecessary use of chest X-rays" Chai et al (2021).

ECG PICC tip location in critically ill patients

Abstract:

Background: We compared the methods of electrocardiogram (ECG) and X-ray localization of the peripherally inserted central catheter (PICC) tip position, in order to find a more convenient, practical, and safe method.

Objective: To investigate the value of applying electrocardiographic localization of the PICC tip position in critically ill patients with advanced cancer in Hebei Province, China.

Method: Enrolled 137 advanced cancers requiring PICC placement. The position of the catheter tip was localized with the bedside electrocardiogram in real time. Then, the localization was performed using a chest X-ray (the gold standard). The accuracy of electrocardiographic location was checked.

Results: Specific P waves were observed in 130 patients. No change in the P waves was observed for the remaining seven patients. The age of the latter group of patients was more advanced (87.29 [5.15] years), a significant difference to that of the 130 patients with specific P waves (71.58 [14.84] years) (t = -6.704, p < .001). Specific P waves not only involve ascendance in P waves but also ascendance in QRS waves.

Conclusions: The use of an ECG to localize the PICC tip in critically ill patients with advanced cancer may replace the unnecessary use of chest X-rays. Specific P waves not only involve an increase in P waves but also an increase in QRS waves. If there is no change in the P wave, a chest X-ray film must be obtained. In elderly patients, because there is a possibility of catheter tip malposition, a comprehensive evaluation should be performed before surgery.


Reference:

Chai YH, Han SY, Zhu YX, Hou JJ, Guan XH, Yin XX, Zhang FY, Qiao QZ, Han LM, Li J. Electrocardiographic localization of peripherally inserted central catheter tip position in critically ill patients with advanced cancer: An application study. Ann Noninvasive Electrocardiol. 2021 Dec 24:e12918. doi: 10.1111/anec.12918. Epub ahead of print. PMID: 34951713.