Intracavitary electrocardiography CVC tip positioning in neonates

We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients” Capasso et al (2018).

Abstract:

PURPOSE: The neonatologists of Sant’Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning.

PATIENTS AND METHODS: We enrolled 39 neonates (1-28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head-neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates.

RESULTS: No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction-target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected.

CONCLUSION: We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if “peak” P wave is detected.



Reference:

Capasso, A., Mastroianni, R., Passariello, A., Palma, M., Messina, F., Ansalone, A., Bernardo, I., Brescia, D., Crispino, F., Grassia, C., Romano, A. and Ausanio, G. (2018) The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study. The Journal of Vascular Access. March 1st. .

doi: 10.1177/1129729818761292.

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