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"Catheter withdrawal until the P wave reverted to normal indicated that a tip position close to the inferior vena cava above the diaphragm level was ideal" Duan et al (2021).

Intracavitary ECG for FICC placement

Abstract:

Background: In this study, the intracavitary electrocardiogram (ECG) P-wave and QRS-wave changes during femorally inserted central catheter (FICC) placement in adults were observed with the aim of reducing malposition occurrence. The observed method provides venous access in patients who have limited upper limb venous catheterization potential and require medium-term and long-term infusions.

Methods: A retrospective analysis of 34 adult patients who underwent FICC placement was conducted. After body surface measurements were taken, all patients were connected to an ECG during catheter placement, and the P-wave and QRS-wave changes were observed. Next, the catheter tip position was confirmed with an abdominal X-ray, and an analysis of the changes occurring during the procedure was conducted.

Results: In the 34 patients included in the present study, the catheter tips were located below the diaphragm level in the inferior vena cava. Of the patients, 18 showed negative P waves, biphasic P waves, and positive high-amplitude P waves with increasing the insertion depth. In 16 patients, no P-wave characteristic changes were observed during catheterization, and an abdominal X-ray confirmed that the catheter tip was positioned below the level of the first lumbar vertebra.

Conclusion: Negative P waves, biphasic P waves, and positive high-amplitude P waves appeared during FICC placement in adults. Catheter withdrawal until the P wave reverted to normal indicated that a tip position close to the inferior vena cava above the diaphragm level was ideal.


Reference:

Duan Y, Hu X, Zhu Y, Zhao X, Yin X, Zhang H, Wang Y. Intracavitary electrocardiography for femorally inserted central catheter tip location in adult patients. Ann Noninvasive Electrocardiol. 2021 Dec 24:e12922. doi: 10.1111/anec.12922. Epub ahead of print. PMID: 34953005.