ECG PICC tip positioning
Abstract:
Objective: This study aimed to analyze the application value of intracavitary electrocardiogram (ECG) classification in peripherally inserted central catheter (PICC) tip localization in patients with cancer.
Methods: Using a self-control study method, 325 patients with cancer underwent intracavitary ECGs to position the tip of a PICC catheter. The P wave, QRS wave amplitude, and waveform changes of each intracavitary ECG were recorded. Chest X-ray examination was performed after the catheterization to compare the results of different intracavity ECG maps with the results of the chest X-ray.
Results: The intracavitary ECG positioning maps of the 325 patients were divided into four categories: (1) increased P wave (293 cases), accounting for 90.15% (293/325) of all cases; compared with the positioning results of the chest X-rays, the placement rate was 98.98% (290/293); (2) negative deepening of the P wave (1 case), accounting for 0.31% (1/325) of all cases and with a placement rate of 100% (1/1); (3) no change in P wave (19 cases), accounting for 5.85% (19/325) of all cases and with a placement rate of 42.11% (8/19); (4) atrial fibrillation/atrial flutter (12 cases), accounting for 3.69% (12/325) of all cases and with a placement rate of 58.33% (7/12). The four types of intracavitary ECG positioning maps had statistically significant differences (χ2 = 133.924, P = 0.000).
Conclusion: There are four types of intracavitary ECG localization maps: increased P wave, negative deepening of the P wave, no change in P wave, and atrial fibrillation/atrial flutter. The increased P wave pattern had the highest occurrence probability and high positioning accuracy. It therefore has strong clinical application value for PICC tip localization in patients with cancer.
Reference:
Li J, Chai Y, Zhu Y, Shen J, Liu S, Hu M, Qi Z. Application of intracavitary electrocardiogram classification in peripherally inserted central catheter localization in cancer patients. J Electrocardiol. 2021 Nov 30;70:39-44. doi: 10.1016/j.jelectrocard.2021.11.034. Epub ahead of print. PMID: 34902731.