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"P-wave changes during IC-ECG have high accuracy in determining the location of the tip of the PICC" Zhu et al (2021).
Intracavitary ECG guided PICC in newborns

Abstract:

Background: The present study aimed to investigate the P-wave changes in intracavitary electrocardiography (IC-ECG) during catheterization with a peripherally inserted central catheter (PICC) in order to provide guidance for the accurate localization of the tip of the PICC.

Methods: A total of 106 newborns who needed a PICC were randomly divided into two groups-a study group and a control group-using a random number table, with 53 cases in each group. In the study group, the ECG monitor was connected after the successful puncture and insertion of the PICC into the right sternoclavicular joint, and the position of the catheter tip was determined according to the P-wave changes on the IC-ECG. Localization X-rays were taken at the same time. In the control group, after the successful routine puncture and insertion of the PICC into the location to a predetermined length, localization X-rays were taken. The accuracy, procedure duration, and cost of the two localization methods were evaluated.

Results: The accuracy of the localization in the study group was 92.5%, but the difference was not significant when compared with the control group (P>0.05). The duration of the procedure in the study group was 5.12±1.57 minutes, and the cost was 7.12±0.56 yuan, both of which were significantly different when compared with the control group (P<0.05).

Conclusions: P-wave changes during IC-ECG have high accuracy in determining the location of the tip of the PICC. It is also a simple method and has certain clinical application value.

Trial registration: Chinese Clinical Trial Registry (number: ChiCTR2100047660).

Reference:

Zhu LB, Liu L, Zhang TS, Zheng YT, Lu CY, Lu K, Zhang SX, Duan LY, Yang ML. A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial. Transl Pediatr. 2021 Oct;10(10):2409-2417. doi: 10.21037/tp-20-370. PMID: 34765464; PMCID: PMC8578775.