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Cîrstoveanu C, Bratu A, Filip C, Bizubac M. The Role of POCUS and Monitoring Systems during Emergency Pericardial Effusion in the NICU. Life (Basel) 2024; 14:1104. [PMID: 39337888 PMCID: PMC11433190 DOI: 10.3390/life14091104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Central venous catheterization is, now, one of the most routinely used procedures in the NICUs, helping during the care of very sick infants. Pericardial effusion is a very rare but severe complication, with a high mortality. The cases described are part of an ongoing retrospective study where the use of central catheters inserted in our surgical NICU, and its complications is being analyzed. 16 cases over 13 years are presented in this article, varying in severity from mild, self-resolving cases that were discovered during routine cardiac POCUS to cases with important hemodynamic impact associated with cardiac tamponade and cardiac arrest. Due to immediate intervention, only one of the cases led to catheter-related mortality and that was under particular conditions. Our aim is to highlight the severity of this complication, the importance of early intervention, and the impact of a highly technologized unit and widely available cardiac POCUS.
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Affiliation(s)
- Cătălin Cîrstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Alexandra Bratu
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
- Department of Pediatrics, Pediatric Cardiology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
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Natile M, Ancora G, D'Andrea V, Pittiruti M, Barone G. A narrative review on tip navigation and tip location of central venous access devices in the neonate: Intracavitary ECG or real time ultrasound? J Vasc Access 2024:11297298241259247. [PMID: 39090995 DOI: 10.1177/11297298241259247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
The proper location of the tip of a central venous access device plays a crucial role in minimizing the risks potentially associated with its use. Recent guidelines strongly recommend preferring real-time, intra-procedural methods of tip location since they are more accurate, more reliable and more cost-effective than post-procedural methods. Intracavitary electrocardiography and real time ultrasound can both be applied in the neonatal setting, but they offer different advantages or disadvantages depending on the type of central venous access device. Reviewing the evidence currently available about the use of these two methods in neonates, in terms of applicability, feasibility and accuracy, it can be concluded that (a) real time ultrasound is the only acceptable methodology for tip navigation for any central venous access device in neonates, (b) intracavitary electrocardiography is the preferred method of tip location for central catheters inserted by ultrasound-guided cannulation of the internal jugular vein or the brachiocephalic vein, and (c) real time ultrasound is the preferred method of tip location for umbilical venous catheters, epicutaneo-cava catheters, and central catheters inserted by ultrasound-guided cannulation of the common femoral vein.
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Affiliation(s)
- Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
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Pittiruti M, Crocoli A, Zanaboni C, Annetta MG, Bevilacqua M, Biasucci DG, Celentano D, Cesaro S, Chiaretti A, Disma N, Mancino A, Martucci C, Muscheri L, Pini Prato A, Raffaele A, Reali S, Rossetti F, Scoppettuolo G, Sidro L, Zito Marinosci G, Pepe G. The pediatric DAV-expert algorithm: A GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access device in children. J Vasc Access 2024:11297298241256999. [PMID: 38856094 DOI: 10.1177/11297298241256999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
In pediatric patients, the choice of the venous access device currently relies upon the operator's experience and preference and on the local availability of specific resources and technologies. Though, considering the limited options for venous access in children if compared to adults, such clinical choice has a great critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems fully satisfactory and useful in clinical practice. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in children. After a systematic review of the available evidence, the panel of the consensus (which included Italian experts with documented competence in this area) has provided structured recommendations answering 10 key questions regarding the choice of venous access both in emergency and in elective situations, both in the hospitalized and in the non-hospitalized child. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Bambino Gesù Children Hospital IRCCS, Rome Italy
| | - Clelia Zanaboni
- Department of Anesthesia and Intensive Care, University Hospital, Parma, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, Catholic University Hospital "A.Gemelli," Rome, Italy
| | | | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
| | - Davide Celentano
- Department of Oncology, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Simone Cesaro
- Department of Pediatric Oncology and Hematology, University Hospital, Verona, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Nicola Disma
- Unit for Research in Anaesthesia, Gaslini Children Hospital IRCCS, Genova, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Cristina Martucci
- Surgical Oncology Unit, Bambino Gesù Children Hospital IRCCS, Rome Italy
| | - Lidia Muscheri
- Pediatric Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Alessio Pini Prato
- Pediatric Surgery Unit, Umberto Bosio Center for Digestive Diseases, Children Hospital, Alessandria, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child Health, San Matteo Hospital IRCCS, Pavia, Italy
| | - Simone Reali
- Surgical Oncology Unit, Bambino Gesù Children Hospital IRCCS, Rome Italy
| | - Francesca Rossetti
- Department of Anesthesia and Intensive Care, Meyer Children Hospital IRCCS, Firenze, Italy
| | | | - Luca Sidro
- Department of Anesthesia and Intensive Care, Santobono-Pausilipon Children Hospital, Napoli, Italy
| | - Geremia Zito Marinosci
- Department of Anesthesia and Intensive Care, Santobono-Pausilipon Children Hospital, Napoli, Italy
| | - Gilda Pepe
- Department of Surgery, Catholic University Hospital "A.Gemelli," Rome, Italy
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Pittiruti M, Salerno G, Mancino A, Carlini D, Celentano D, Annetta MG, Conti G. Ultrasound versus intracavitary electrocardiography for intraprocedural tip location during central venous catheterization in infants and children: A prospective clinical study. J Vasc Access 2024; 25:774-778. [PMID: 36267035 DOI: 10.1177/11297298221132415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both intracavitary electrocardiography (IC-ECG) and ultrasound (US) have been proven to be safe and accurate for intraprocedural tip location during central venous catheterization, and both are known to be easily applicable and feasible in pediatric patients. Though, no prospective clinical study has directly compared the two methods as regards their applicability, feasibility, and procedural time. METHODS This study prospectively enrolled all children requiring a central venous access device in non-emergency situations, during a period of 1 year. All devices were inserted according to a well-defined insertion bundle including both IC-ECG and US-based tip location. The primary endpoint of the study was to compare the two methods in terms of applicability, feasibility and time required. RESULTS This study included 100 consecutive central venous catheterizations in children of age ranging from 1 month to 18 years. The applicability of IC-ECG based tip location was 98% and its feasibility 100%; the time required for IC-ECG was 1.9 ± 2 min. The applicability of US-based tip location was 96% and its feasibility was 100%; the maneuver required 2.2 ± 3 min. CONCLUSIONS US is an appropriate alternative method for intraprocedural tip location in children. The combined use of US and IC-ECG (both maneuvers being accurate, inexpensive, cost-effective, non-invasive, and equally fast to perform) should be recommended for tip location in pediatric patients, and it will avoid completely the use of fluoroscopy or of post-procedural x-ray.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Gilda Salerno
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Debora Carlini
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Davide Celentano
- Department of Oncology, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
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Liu B, Liu Y, Li J, Kang J, Sun W. A feasible and safe standardized protocol for ultrasound and intracavitary electrocardiogram-based tip navigation and tip location during placement of peripherally inserted central catheters. J Vasc Access 2024; 25:935-942. [PMID: 36527184 DOI: 10.1177/11297298221095039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are performed for medium and long term intravenous therapy. The most recent guidelines recommend the use of ultrasound-guided venipuncture to reduce surgery-related complications. In recent years, bedside ultrasound has also been used as evidence of accuracy in tip navigation and tip positioning. This paper is aimed to investigate using tip navigation with the ultrasonic technique and intracavitary electrocardiogram during the catheterization, and to suggest a feasible and safe standardized protocol for clinical practice. METHODS A total of 1727 tumor clients who suffered from combined the ultrasonic technique with intracavitary electrocardiogram (ECG + US group) to confirm the tip location of PICC were included in Peking Union Medical College Hospital in 2020. And based on electronic medical records according to the types of cancer as 1:1 to select 1727 cases who only underwent electrocardiogram (ECG group) to verify the tip location of catheters with the same team in 2019. Compared two groups of purpose of catheter, insertion site of upper limbs, times of puncture and delivery catheters, tip location and malposition of peripherally inserted central catheter, and analysis of the safety and feasibility. RESULTS There were no significant differences between the two groups in the purpose of catheter, insertion site of upper limbs, times of puncture, and delivery catheters. The percentage of optimal tip location in ECG + US group was significantly higher than that in ECG group, and the rate of malposition of catheters was obviously lower than that in ECG group (p < 0.001). CONCLUSIONS Tip navigation based with ultrasound and intracavitary electrocardiogram has high accuracy to confirm tip location of PICC, and it is also feasible and safe, which can not only to make up for the deficiency of patients without surface P waves who could not be applied ECG but also to fit for all patients.
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Affiliation(s)
- Bing Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Yan Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Jiaqian Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Junren Kang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Wenyan Sun
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
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Annetta MG, Celentano D, Zumstein L, Attinà G, Ruggiero A, Conti G, Pittiruti M. Catheter-related complications in onco-hematologic children: A retrospective clinical study on 227 central venous access devices. J Vasc Access 2024; 25:512-518. [PMID: 36113076 DOI: 10.1177/11297298221122128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The use of central venous access devices (CVADs) is of paramount importance to safely deliver antiblastic and support therapies in children with cancer. Though, in pediatric patients, as much as in adults, CVADs are potentially associated with severe complications which may result in unscheduled interruption of therapy, hospitalization, increased morbidity/mortality, and increased cost of care. METHODS We have reviewed retrospectively our experience with CVADs in children with solid tumors and hematologic diseases, with the purpose of verifying if the adoption of well-defined insertion and maintenance bundles might be effective in reducing catheter-related complications, and in particular catheter-related thrombosis. RESULTS A total of 227 CVADs were analyzed: 175 peripherally inserted central catheters (PICCs), 50 centrally inserted central catheters (CICCs), and 2 femorally inserted central catheters. All CVADs were non-valved, non-cuffed power injectable polyurethane catheters; 81% were tunneled. Median dwelling time of CVADs was 172 days, for a total number of 39,044 catheter days. A very low incidence of both symptomatic catheter-related thrombosis (0.9%) and catheter-related blood stream infection (0.56 episodes per 1000 catheter days) was found. Unscheduled removal or guidewire replacement because of mechanic complications occurred in 15.7% of CVADs. There was no difference in terms of complications between PICCs and CICCs or between tunneled and non-tunneled catheters. CONCLUSIONS Our experience with CVADs in oncologic and hematologic children suggests that catheter-related complications may be minimized by the adoption of appropriate insertion and maintenance bundles.
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Affiliation(s)
- Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Davide Celentano
- Department of Oncology, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Lucrezia Zumstein
- Department of Pediatric Oncology, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Giorgio Attinà
- Department of Pediatric Oncology, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Antonio Ruggiero
- Department of Pediatric Oncology, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A.Gemelli," Rome, Italy
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Annetta MG, Marche B, Giarretta I, Pittiruti M. Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients. J Vasc Access 2024; 25:651-657. [PMID: 36765466 DOI: 10.1177/11297298231153979] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The ideal intraprocedural method for tip location during insertion of femorally inserted central catheters (FICCs) is still a matter of debate. When the catheter tip is meant to be in the right atrium or in the supradiaphragmatic inferior vena cava (IVC), tip location by either intracavitary electrocardiography or transthoracic echocardiography may be accurate and easy to perform. When the catheter tip is planned to be placed in the subdiaphragmatic IVC, fluoroscopy-though inaccurate and unsafe-has been regarded as the only option for intraprocedural tip location. METHODS We have investigated prospectively the applicability and feasibility of transhepatic ultrasound as intraprocedural method for assessing the location of the catheter tip in the subdiaphragmatic tract of IVC, during FICC insertion. RESULTS We enrolled 169 consecutive patients undergoing FICC insertion by ultrasound guided puncture of the superficial femoral vein. In 165 out of 169 patients, the subdiaphragmatic IVC was visualized by the transhepatic ultrasound view. In all cases of IVC visualization, the catheter tip could be identified by ultrasound, either directly (direct evidence of the tip inside the vein) or indirectly (enhanced visualization of the tip after "bubble test"). There was no immediate or early complication, and very few late complications. CONCLUSION The intraprocedural method of tip location of FICCs by transhepatic ultrasound was applicable in 97.6% of cases and feasible in 100%. When the position of the catheter tip is planned to be in the subdiaphragmatic IVC, this method of tip location is accurate, safe, and inexpensive, and should be considered as an alternative to fluoroscopy.
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Affiliation(s)
| | - Bruno Marche
- Vascular Access Team, Fondazione Policlinico Universitario "A.Gemelli," Roma, Italy
| | - Igor Giarretta
- Department of Emergency of High-Specialty and Medical Center, ASST-Settelaghi, Varese, Italy
| | - Mauro Pittiruti
- Vascular Access Team, Fondazione Policlinico Universitario "A.Gemelli," Roma, Italy
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Sanna G, Camporesi A, Diotto V, Abbiati G, Torri A, Gemma M. Virtual sedation as a substitute to pharmacological sedation during PICC placement in pediatric patients: A feasibility study. J Vasc Access 2024; 25:313-317. [PMID: 35773952 DOI: 10.1177/11297298221085424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In pediatric patients, PICC insertion is often performed under sedation to reduce pain and anxiety, which is associated with risks such as laryngospasm, apnea, and hypoxia. Furthermore, it requires a pediatric anesthesiologist. The aim of our study was to evaluate the VR as an alternative to pharmacological sedation to reduce those risks and the overall cost. METHODS We tested a VR immersive experience for ten children requiring a PICC. To achieve this, we ran a software, specifically designed for the pediatric healthcare setting, on a commercially available VR headset.In order to evaluate this new practice, we recorded the following data:Patient's anxiety before and after the procedure, recorded through a modified numeric rating scale from 0 (no anxiety) to 10 (worst anxiety imaginable).Patient's pain before (e.g., because of preexisting medical conditions) and after the procedure through a Wong-Baker scale.Caregiver's satisfaction.No active or passive restraint was enforced during the whole procedure, patients had to keep their arms still all by themselves. RESULT Out of the 10 patients only in a single case, we had to interrupt the attempt with the VR technique and let the anesthesiologist perform a sedation. From the immediate beginning said patient had trouble adapting to the virtual environment and tried to remove the headset.In all other cases, we noticed a drop in the anxiety level of the patient and the pain never increased. Globally, caregivers were pleased with the experience and reported an average satisfaction rate of 9.3 out of 10. CONCLUSION Virtual reality seems a valid alternative to traditional sedation in pediatric patients undergoing a PICC placement procedure. Additional studies, with adequate sample size, of patients are necessary to assess the benefit from this new approach, as well as its impact on the overall procedure length.
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Affiliation(s)
- Gianuario Sanna
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Lombardy, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children Hospital, Milan, Lombardy, Italy
| | - Veronica Diotto
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children Hospital, Milan, Lombardy, Italy
| | - Giacomo Abbiati
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Lombardy, Italy
| | - Adriano Torri
- Specialist on vascular access, Becton, Dickinson and Company, Milano, Lombardia, Italy
| | - Marco Gemma
- Department of Neuroanesthesia and Critical Care, "Carlo Besta" Neurological Institute, Milan, Italy
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Gao J, Zhu Y, Zhang C, Yin X. Effect of intracavitary electrocardiographic localization on the success rate and complications of PICC in infants. Technol Health Care 2024; 32:663-673. [PMID: 37483031 DOI: 10.3233/thc-230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Peripherally inserted central catheter (PICC) is widely used in chemotherapy of children with malignant tumors because of its safe operation and long indwelling time. OBJECTIVE To investigate the effect of intracavitary electroencephalogram (CEEG) localization technique on the success rate and complications of PICC in infants. METHODS A total of 180 children with PICC catheterization and maintenance at Shijiazhuang People's Hospital First Hospital from January 2017 to January 2020 were selected and divided into control group (n= 90 cases) and observation group (n= 90 cases). The control group observed the tip position of the fixed catheter through X-ray film and adjusted the catheter until its tip was located in the superior vena cava. The observation group used intracavitary electrocardiogram positioning technology. Comparison of the effects of two groups on the success rate and complications of PICC puncture in infants and young children. RESULTS The success rate of one puncture in the observation group was significantly higher than that in the control group (P< 0.05). Within one month of catheterization, 13 cases had complications, with an incidence rate of 16.00% lower than the control group's 34.00% (27/80) (P< 0.05). The screening test results showed that the specificity, sensitivity, Youden index, accuracy, kappa coefficient, positive and negative predictive value were 88.89%, 97.56%, 0.86, 96.00%, 0.86, 0.86, respectively. The measured values were 97.56% and 88.89% respectively, and the cost and time of localization were lower than those of X-ray. CONCLUSION The technique of intracavitary electrogram can be more accurate for infants to place the tip of central venous catheter through peripheral vein, which can effectively improve the success rate of one puncture with low cost, and has high reliability, accuracy and practicability, which is safe and effective.
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Alexandrou E, Mifflin N, McManus C, Sou V, Frost SA, Sanghavi R, Doss D, Pillay S, Lawson K, Aneman A, Konstantinou E, Rickard CM. A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement. J Vasc Access 2023; 24:1372-1380. [PMID: 35394395 DOI: 10.1177/11297298221085228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. METHODS Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG (n = 172) or traditional (n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. RESULTS Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9-24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference-19.9 min (95% CI-14.6 to -34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. CONCLUSIONS Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. TRIAL REGISTRATION This trial is registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au). The registration number is ACTRN12620000919910.
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Affiliation(s)
- Evan Alexandrou
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Australia
| | - Nicholas Mifflin
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
| | - Craig McManus
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
| | - Vanno Sou
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
- Department of Anaesthetics, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Steven A Frost
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Ritesh Sanghavi
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - David Doss
- Department of Radiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Sugendran Pillay
- Department of Radiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Evangelos Konstantinou
- Faculty of Nursing at National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Australia
- University of Queensland, Queensland, Australia
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Pittiruti M, Celentano D, Barone G, D'Andrea V, Annetta MG, Conti G. A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases. J Vasc Access 2023; 24:1477-1488. [PMID: 35533085 DOI: 10.1177/11297298221074472] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. METHODS The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. RESULTS All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. CONCLUSION The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, University Hospital "A. Gemelli," Rome, Italy
| | - Davide Celentano
- Pediatric Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, "Infermi" Hospital, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
| | | | - Giorgio Conti
- Pediatric Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
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12
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D'Andrea V, Pezza L, Prontera G, Ancora G, Pittiruti M, Vento G, Barone G. The intracavitary ECG method for tip location of ultrasound-guided centrally inserted central catheter in neonates. J Vasc Access 2023; 24:1134-1139. [PMID: 35081816 DOI: 10.1177/11297298211068302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The correct position of the tip of a central venous access device is important in all patients, and especially in neonates. The traditional method of tip location (approximated intra-procedural length estimation + post procedural chest X-ray) is currently considered inaccurate and not cost-effective by most recent guidelines, which recommend the adoption of tip location by intracavitary electrocardiography (IC-ECG) whenever possible. METHODS This study prospectively investigated the applicability, the feasibility, the accuracy, and the safety IC-ECG for tip location in neonates requiring insertion of ultrasound-guided centrally inserted central venous catheters (CICCs) with caliber 3Fr or more. All catheter tip locations were verified using simultaneously both IC-ECG and ultrasound-based tip location, using the Neo-ECHOTIP protocol. RESULTS A total of 105 neonates were enrolled. The applicability of IC-ECG was 100% since a P wave was evident on the surface ECG of all neonates recruited for the study. The feasibility was also 100% since an increase of the P-wave was detected in all cases. The accuracy was also 100%, since a perfect match between IC-ECG based tip location and ultrasound-based tip location was found. There were no adverse events directly or indirectly related to the IC-ECG technique; no arrhythmias occurred. CONCLUSIONS When applied to ultrasound guided CICCs, tip location by IC-ECG is applicable and feasible in neonates, and it is safe and accurate.
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucilla Pezza
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
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13
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Lamberti G, Domenichelli V, Straziuso S, Pelusi G, Natile M, Ancora G, Barone G. Use of the Dialkylcarbamoylchloride Dressing in the Care of Central Venous Access Exit Site in a Pediatric and Neonatal Population. Diagnostics (Basel) 2023; 13:diagnostics13091520. [PMID: 37174912 PMCID: PMC10177172 DOI: 10.3390/diagnostics13091520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Dialkylcarbamoylchloride dressing is a fatty acid derivative that has been shown in vitro to bind a number of pathogenic microorganisms. The purpose of this prospective study was to evaluate the safety and the efficacy of this technology in the care of the exit site of central venous catheter in a paediatric and neonatal population. METHODS The study was conducted from September 2020 to December 2022 at the Infermi Hospital in Rimini. Central venous catheters were placed using the SIC bundle for insertion. Dialkylcarbamoylchloride dressing was placed below the subcutaneous anchoring at the time of CVC placement and at each dressing change. Data about the catheters and the exit site were recorded and then compared with an historical cohort. RESULTS 118 catheters were placed during the studied period. The dialkylcarbamoylchloride dressing was well-tolerated. No case of systemic or local infection was recorded. The comparison with the historical cohort showed a reduction in the rate of exit site infection (p value 0.03). CONCLUSION Dialkylcarbamoylchloride dressing is well-tolerated in paediatric and neonatal population. It represents a promising tool as a strategy for infection prevention.
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Affiliation(s)
- Giorgio Lamberti
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | | | - Simona Straziuso
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Gabriella Pelusi
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
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14
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Gan W, Hu L, Luo Y, Tang M. Impact of peripherally inserted central venous catheter-associated phlebitis in neonate guided by intracavitary electrocardiogram: A systematic review and meta-analysis of randomised controlled trials. Int Wound J 2023; 20:1130-1138. [PMID: 36220149 PMCID: PMC10031215 DOI: 10.1111/iwj.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
Because the application of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) in the treatment of neonates is controversial in terms of phlebitis reduction compared with traditional X-ray positioning technique, a systematical evaluation is needed on the impact of IC-ECG on this common complication following PICC. Literature retrieval was conducted on large databases including PubMed, Google Scholar, Cochrane library, and CNKI. Randomised controlled trials (RTCs) of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in the treatment of neonates up to July 7, 2022, were collected. Then indicators of included studies were compared and analysed by two researchers. Meta-analysis was performed on the STATA 17.0 software. After excluding invalid trials, 11 out of 316 randomised controlled trials were included for further analysis. Meta-analysis results showed that compared with the control group, IC-ECG-guided PICC could decrease the incidence of phlebitis (I2 = 0.00%, P = 0.76, OR = 0.33, 95% CI 0.19-0.56) and that no significant difference was observed between preterm neonates and term neonates (P = 0.74). Meanwhile, total complications were decreased in neonates (I2 = 0.00%, P = 0.00 OR = 0.23, 95% CI 0.16-0.33). IC-ECG-guided PICC could also improve the accuracy of optimal tip location (I2 = 0.00%, P = 0.53, OR = 5.37, 95% CI 3.80-7.59). IC-ECG-guided PICC could achieve reduced phlebitis incidence and total complications in the treatment of neonates, as well as increased accuracy of optimal tip location, no matter if those neonates were preterm or not. This study was registered in inplasy.com with No. INPLASY202280012 (DOI: 10.37766/inplasy2022.8.0012).
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Affiliation(s)
- Wenyi Gan
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Hu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yulan Luo
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Menglin Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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15
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Garcia-Leal M, Guzman-Lopez S, Verdines-Perez AM, de Leon-Gutierrez H, Fernandez-Rodarte BA, Alvarez-Villalobos NA, Martinez-Garza JH, Quiroga-Garza A, Elizondo-Omaña RE. Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis. J Vasc Access 2023; 24:338-347. [PMID: 34254560 DOI: 10.1177/11297298211031339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.
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Affiliation(s)
- Mariana Garcia-Leal
- School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Santos Guzman-Lopez
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Humberto de Leon-Gutierrez
- School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Neri Alejandro Alvarez-Villalobos
- School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
- Instituto Mexicano del Seguro Social, Delegación de Nuevo Leon, Monterrey, Mexico
| | | | - Alejandro Quiroga-Garza
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
- Instituto Mexicano del Seguro Social, Delegación de Nuevo Leon, Monterrey, Mexico
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16
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Zito Marinosci G, Biasucci DG, Barone G, D'Andrea V, Elisei D, Iacobone E, La Greca A, Pittiruti M. ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients. J Vasc Access 2023; 24:5-13. [PMID: 34256613 DOI: 10.1177/11297298211031391] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.
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Affiliation(s)
- Geremia Zito Marinosci
- UOC di Rianimazione e Neuroanestesia, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Neaples, Italy
| | - Daniele Guerino Biasucci
- Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi di Rimini, Azienda Unità Sanitaria Locale della Romagna, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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17
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Weber MD, Conlon T, Woods-Hill C, Watts SL, Nelson E, Traynor D, Zhang B, Davis D, Himebauch AS. Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients. Pediatr Crit Care Med 2022; 23:192-200. [PMID: 34999641 PMCID: PMC8897221 DOI: 10.1097/pcc.0000000000002882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. DESIGN Single-center retrospective cohort study. SETTING Quaternary academic PICU. PATIENTS Children greater than 1 month to less than 18 years who had a CVC placed between January 2014 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the CVC tip position located on the first postprocedural radiograph. CVC tip was defined as follows: "recommended" (tip location between the carina and two vertebral bodies inferior to the carina), "high" (tip location between one and four vertebral bodies superior to the carina), "low" (tip position three or more vertebral bodies inferior to the carina), and "other" (tip grossly malpositioned). Seven hundred eighty-one CVCs were included: 481 (61.6%) were in "recommended" position, 157 (20.1%) were "high," 131 (16.8%) were "low," and 12 (1.5%) were "other." Multiple multinomial regression (referenced to "recommended" position) showed that left-sided catheters (adjusted odds ratio [aOR], 2.00, 95% CI 1.17-3.40) were associated with "high" CVC tip positions, whereas weight greater than or equal to 40 kg had decreased odds of having a "high" CVC tip compared with the reference (aOR, 0.45; 95% CI, 0.24-0.83). Further, weight category 20-40 kg (aOR, 2.42; 95% CI, 1.38-4.23) and females (aOR, 1.51; 95% CI, 1.01-2.26) were associated with "low" CVC tip positions. There was no difference in rates of central line-associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between the CVCs with tips outside and those within the recommended location. CONCLUSIONS The prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.
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Affiliation(s)
- Mark D. Weber
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charlotte Woods-Hill
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie L. Watts
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Eileen Nelson
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Danielle Traynor
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Bingqing Zhang
- Children’s Hospital of Philadelphia, Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit
| | - Daniela Davis
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam S. Himebauch
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Weber MD, Himebauch AS, Conlon T. Use of intracavitary-ECG for tip location of femorally inserted central catheters. J Vasc Access 2022; 23:166-170. [PMID: 33356809 DOI: 10.1177/1129729820982864] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Femorally inserted central catheters (FICCs) are frequently required for central access in children. Ultrasound can accurately locate the catheter tip in most cases and its use is increasing in clinical vascular access practice. In patients with poor acoustic windows, intracavitary electrocardiogram (IC-ECG) is an alternative to ultrasound-guidance for FICC positioning. A case series of three patients demonstrate methods of FICC positioning in children. The first patient had excellent acoustic windows and ultrasound-guided FICC positioning is described in conjunction with IC-ECG measurements. The following two patients had poor acoustic windows, thus IC-ECG guided FICC tip position. The use of FICCs in children has increased in recent years. Ultrasound has emerged as a reliable method of assessing FICC tip location. IC-ECG is an accurate and complementary method of assessing FICC tip location, but can be a primary method when ultrasound is not available or cannot directly visualize the catheter. IC-ECG P-wave characteristics identify optimal tip position at the inferior cavoatrial junction and are different from characteristics at the superior cavoatrial junction.
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Affiliation(s)
- Mark D Weber
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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19
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Spencer TR, Pittiruti M, Miluy GO, Pacilli M. Letter Regarding: Open Versus Ultrasound Guided Tunneled Central Venous Access in Children: A Randomized Controlled Study. J Surg Res 2021; 267:712-714. [PMID: 34905819 DOI: 10.1016/j.jss.2021.04.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy; World Congress of Vascular Access (WoCoVA) and Gli Accessi Venosi Centrali a Lungo Termine (GAVeCeLT)
| | | | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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20
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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; 10:2409-2417. [PMID: 34765464 PMCID: PMC8578775 DOI: 10.21037/tp-20-370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/20/2021] [Indexed: 11/06/2022] Open
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).
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Affiliation(s)
- Li-Bo Zhu
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Ling Liu
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Tie-Song Zhang
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Yu-Ting Zheng
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Chun-Yan Lu
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Kun Lu
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Shu-Xian Zhang
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Liu-Yan Duan
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Mei-Lin Yang
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
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21
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Sun W, Li J, Liu B, Liu Y, Ge R, Wang K, Zhang J, Wu X. Effects of indwelling centrally inserted central catheter on tip location of peripherally inserted central catheter with intracavitary electrocardiogram guidance: A retrospective case-control study. J Vasc Access 2021; 24:379-384. [PMID: 34296629 DOI: 10.1177/11297298211015088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Intracavity electrocardiogram (IC-ECG) guidance is an effective technology for monitoring the tip locations of centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs). However, for patients with an indwelling CICC, there has been no study on whether the CICC affects PICC tip positioning with IC-ECG guidance. METHODS Thirty people with a CICC requiring PICC insertion, matched with age to controls without a CICC. The stability of IC-ECG waveforms, the amplitude of P-waves, and the accuracy of PICC tip location were compared. RESULTS There was no significant difference in the stability of the IC-ECG waveforms (χ2 = 0.22, p = 0.64). The amplitudes of baseline P-waves and ideal P-waves also showed no significant difference (t1 = 0.06, p1 = 0.96, t2 = 0.80, p2 = 0.43). Neither the accuracy of tip location (χ2 = 1.40, p = 0.50) nor the distance of PICC tip (t = -0.03, p = 0.98) were significantly different. CONCLUSION For patients with an indwelling CICC, the position of PICC tip can be accurately determined by the dynamic changes in the P-wave amplitude.
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Affiliation(s)
- Wenyan Sun
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Jiaqian Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Bing Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Yue Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Ruibin Ge
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Kai Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Jingyan Zhang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
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22
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Spagnuolo F, Vacchiano T. Ultrasound-guided cannulation of the brachiocephalic vein in newborns: A novel approach with a supraclavicular view for tip navigation and tip location. J Vasc Access 2021; 23:515-523. [PMID: 33726580 DOI: 10.1177/11297298211001159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Central vascular catheters (CVCs) are frequently used in newborns in NICU. Ultrasound (US) guided supraclavicular venipuncture of the brachiocephalic vein (BCV) is usually performed with a 12 MHz linear probe and then a catheter tip location is verified with an 8 MHz micro-convex probe or intracavitary ECG (IC-ECG). We explored the feasibility of an US guided puncture using a 7 MHz sector probe, positioned on the clavicular sternal joint. We also explored the opportunity of performing it with a probe tilting tip navigation and tip location. DESIGN This is a monocentric retrospective observational study made in the neonatal intensive care unit L. Vanvitelli University Hospital of Naples, Italy. PATIENTS Forty newborns in NICU scheduled for an ultrasound guided CVC. INTERVENTIONS US guided brachiocephalic vein catheterization. We used A long axis in plane supraclavicular approach to the BCV for real time puncture, for tip navigation and tip location, using a 7 MHz sector transducer. We executed an ultrasound pre-scan of the Y-shape (right and left BCV, superior vena cava (SVC)) and of the right pulmonary artery (RPA), and then we performed a guided sterile puncture on middle third of supraclavicular fossa next to clavicular sternal joint with a 7 MHz. We used the same probe for tip navigation by this supraclavicular short axis of ascending aorta view. Tip location was confirmed with the ultrasound and IC-ECG. RESULTS In all infants the ultrasound tip navigation and tip location were successful and were confirmed by IC-ECG. No misplacement, arterial puncture or pneumothorax occurred. CONCLUSIONS The supraclavicular view performed with a 7 MHz sector probe has proved to be completely safe and to be a method with 100% feasibility.
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Affiliation(s)
- Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, University of Study "L. Vanvitelli" Naples, Napoli, Italy
| | - Teresa Vacchiano
- Neonatal Intensive Care Unit, University of Study "L. Vanvitelli" Naples, Napoli, Italy
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Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods. Am J Med 2021; 134:e79-e88. [PMID: 32673624 DOI: 10.1016/j.amjmed.2020.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. METHODS Prospectively collected data from patients that received peripherally inserted central catheters at 52 Michigan hospitals were analyzed. The method used to confirm tip confirmation at insertion and deep vein thrombosis outcomes were extracted from medical records. Multivariate models (accounting for the clustered nature of the data) were fitted to assess the association between peripherally inserted central catheter-related deep vein thrombosis and method of tip confirmation (electrocardiographic vs radiographic imaging). RESULTS A total of 42,687 peripherally inserted central catheters (21,098 radiology vs 21,589 electrocardiographic) were included. Patients receiving electrocardiographic-confirmed peripherally inserted central catheters had fewer comorbidities compared with those that underwent placement via radiology. Overall, deep vein thrombosis occurred in 594 (1.3%) of all peripherally inserted central catheters. Larger catheter size (odds radio [OR] 1.32; 95% confidence interval [CI], 0.93-1.90 per unit increase in gauge), history of deep vein thrombosis, and cancer were associated with increased risk of deep vein thrombosis (OR 2.00; 95% CI, 1.65-2.43 and OR 1.62; 95% CI, 1.16-2.26, respectively) using logistic regression. Following adjustment, electrocardiographic guidance was associated with a significant reduction in peripherally inserted central catheter-related deep vein thrombosis compared with radiographic imaging (OR 0.74; 95% CI, 0.58-0.93; P = .0098). CONCLUSION The use of electrocardiography to confirm peripherally inserted central catheter tip placement at the cavoatrial junction was associated with significantly fewer deep vein thrombosis events than radiographic imaging. Use of this approach for peripherally inserted central catheter insertion may help improve patient safety, particularly in high-risk patients.
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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25
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Pittiruti M, Pelagatti F, Pinelli F. Intracavitary electrocardiography for tip location during central venous catheterization: A narrative review of 70 years of clinical studies. J Vasc Access 2020; 22:778-785. [PMID: 32578489 DOI: 10.1177/1129729820929835] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracavitary electrocardiography is an accurate and non-invasive method for central venous access tip location. Using the catheter as a traveling intracavitary electrode, intracavitary electrocardiography is based on the increase in the detected amplitude of the P wave while approaching the cavoatrial junction. Despite having been adopted diffusely in clinical practice only in the last years, this method is not novel. In fact, it has first been described in the late 40s, during electrophysiological studies. After a long period of quiescence, it is in the last two decades of the XX century that intracavitary electrocardiography became popular as an effective mean of central venous catheters tip location. But the golden age of this technique began with the new millennium, as documented by high-quality studies in this period. In fact, in those years, intracavitary electrocardiography has been studied broadly, and important achievements in terms of comprehension of the technique, accuracy, and feasibility of the method in different populations and conditions (i.e. pediatrics, renal patients, atrial fibrillation) have been gained. In this review, we describe the technique, its history, and its current perspectives.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
| | - Filippo Pelagatti
- School of Human Health Science, University of Florence, Florence, Italy
| | - Fulvio Pinelli
- Anesthesia and Intensive Care, University Hospital Careggi, Florence, Italy
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Chiaretti A, Pittiruti M, Sassudelli G, Conti G, Rossi M, Pulitanò SM, Mancino A, Pusateri A, Gatto A, Tosi F. Comparison between sedation room and operating room in central venous catheter positioning in children. J Vasc Access 2020; 22:184-188. [PMID: 32564667 DOI: 10.1177/1129729820932415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Placement of central venous access devices is a clinical procedure associated with some risk of adverse events and with a relevant cost. Careful choice of the device, appropriate insertion technique, and proper management of the device are well-known strategies commonly adopted to achieve an optimal clinical result. However, the environment where the procedure takes place may have an impact on the overall outcome in terms of safety and cost-effectiveness. METHODS We carried out a retrospective analysis on pediatric patients scheduled for a major neurosurgical operation, who required a central venous access device in the perioperative period. We divided the patients in two groups: in group A the central venous access device was inserted in the operating room, while in group B the central venous access device was inserted in the sedation room of our Pediatric Intensive Care Unit. We compared the two groups in terms of safety and cost-effectiveness. RESULTS We analyzed 47 central venous access devices in 42 children. There were no insertion-related complications. Only one catheter-related bloodstream infection was recorded, in group A. However, the costs related to central venous access device insertion were quite different: €330-€540 in group A versus €105-€135 in group B. CONCLUSION In the pediatric patient candidate to a major neurosurgical operation, preoperative insertion of the central venous access device in the sedation room rather than in the operating room is less expensive and equally safe.
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Affiliation(s)
- Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giovanni Sassudelli
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Marco Rossi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Silvia Maria Pulitanò
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Angela Pusateri
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Federica Tosi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Raffaele A, Segal A, Romano P, Vatta F, Boghen S, Bonetti F, Parigi GB, Avolio L. Intracavitary electrocardiography-guided positioning of central vascular access device can spare unnecessary ionizing radiation exposure in pediatric patients. J Vasc Access 2020; 22:64-68. [PMID: 32452241 DOI: 10.1177/1129729820923936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most hospital protocols-including those of our own institute-require the use of radiography to validate tip position in every central vascular access device placement. This study evaluated whether unnecessary ionizing radiation exposure could be spared in the pediatric population when intracavitary electrocardiography is used to guide catheter placement. MATERIAL AND METHODS Retrospective study of intracavitary electrocardiography-guided central vascular access device placements in our pediatric surgery department between 2013 and 2018. We evaluated the operating time, success in positioning the catheter, and accuracy of final tip position. We also assayed the effects of catheter type and of catheter access point on operating time, success, accuracy, and complications. We applied the chi-square test for statistical analysis. RESULTS In total, 622 interventions of central vascular access device placements were evaluated; 340 intracavitary electrocardiography-guided central vascular access device placements were included in the study. The electrocardiography method successfully positioned the tip of the catheter in 316/340 (92.94%) of placements. Where intracavitary electrocardiography placement was successful, radiography confirmed accuracy of tip position in 314/316 (99.41%) of placements. CONCLUSION When electrocardiography-guided positioning is uneventful and a valid P-Wave pattern is seen, postprocedure radiograph imaging for verification is unnecessary. Any effort should be made to upgrade hospital policies according to evidences and newest guidelines to spare pediatric patients harmful exposure to radiation by limiting the use of radiography only to selected cases.
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Affiliation(s)
- Alessandro Raffaele
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aviad Segal
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Romano
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabrizio Vatta
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stella Boghen
- Department of Pediatric Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Bonetti
- Department of Pediatric Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Battista Parigi
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Avolio
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Wu L, Peng M, Cao T, Yang Y, Wang Q, Luo K, Chen P. Application of a modified electrocardiogram-guided technique for umbilical venous catheterisation in neonates: A retrospective trial. J Paediatr Child Health 2020; 56:716-720. [PMID: 31849129 DOI: 10.1111/jpc.14710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 11/28/2022]
Abstract
AIM To investigate the effectiveness and safety of modified electrocardiogram (ECG)-guided technique in umbilical venous catheterisation in neonates. METHODS Sixty-six critically ill neonates underwent umbilical venous catheterisation with (ECG group) or without (control group) ECG guidance from January 2017 to March 2019. We retrospectively analysed and compared the rate of correct tip placement on first try, unplanned extubation rate and incidence of catheter-related complications between the two groups. RESULTS There were 33 patients in each group. The ECG group showed significantly higher rate of correct tip placement on first try (P < 0.001), lower unplanned extubation rate (P < 0.001), but identical incidence of catheter-related complications (P = 0.492) comparing with the control group. CONCLUSION The ECG-guided technique is an effective and safe method for umbilical venous catheterisation. The connecting method we modified made this technique more practical and can be promoted to areas without access to specific ECG adaptors.
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Affiliation(s)
- Liyuan Wu
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Peng
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tian Cao
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yonghui Yang
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Wang
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kaiju Luo
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Pingyang Chen
- Division of Neonatology, Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
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Li J, Chen W, Zhao W, Zhang H, Huang Z, Zhang S, Li Y. Surface measurement, intracardiac electrocardiogram and tracheal bifurcation techniques for locating the catheter tips of totally implantable venous access port. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105238. [PMID: 31862623 DOI: 10.1016/j.cmpb.2019.105238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The purpose of our study is to compare the reliability and consistency of three commonly used techniques, which are surface measurement, intracardiac electrocardiogram (IECG) and tracheal bifurcation methods in measuring the tip location of totally implantable venous access port (TIVAP) in the same patient. METHODS The thirty-five patients scheduled for implantation of TIVAP were included and right subclavian vein was selected for venous access. We used surface measurement method (Group L) to estimate the length and position of catheter before catheterization, and then we used IECG method (Group E) to confirm the position of catheter during catheterization and after catheterization used tracheal bifurcation method by CT (Group T) for measurement. The differences of catheter length measured by three methods were compared by non-parametric Kruskal-Wallis test. Intraclass correlation coefficient (ICC) was used to evaluate the reliability of three methods and Bland-Altman chart was used to evaluate consistency. RESULTS There are no difference in the length of TIVAP catheter between L and T groups (P > 0.05), but they have significant differences comparing with E group (P < 0.05). The three positioning methods have a good consistency (ICC = 0.886, P < 0.05).Through linear regression analysis, the regression equation are: catheter length (mm) = 77.32 + 0.66 × height (cm), 36.25 + 0.81 × height (cm) and 68.82 + 0.70 × height (cm). The distances from catheter tip to the junction of superior vena cava and right atrium measured by IECG (Group E) was closer to the target value. CONCLUSIONS All three methods can be used to measure the length of TIVAP catheter, and IECG method is the most accurate. And similar to most studies, returning the catheter 20 mm after positioning can avoid catheter entering the right atrium, but we found that 10 mm is a sufficient length to achieve this.
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Affiliation(s)
- Jun Li
- Department of Anesthesiology, Shulan Hospital, No. 848 Dongxin Road, Xiacheng District, Hangzhou 310022, China
| | - Wei Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Wenli Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Hu Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Zeyong Huang
- Department of Anesthesiology, Shulan Hospital, No. 848 Dongxin Road, Xiacheng District, Hangzhou 310022, China
| | - Shuping Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Yuebing Li
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China.
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Elli S, Bellani G, Cannizzo L, Giannini L, De Felippis C, Vimercati S, Madotto F, Lucchini A. Reliability of cutaneous landmarks for the catheter length assessment during peripherally inserted central catheter insertion: A retrospective observational study. J Vasc Access 2020; 21:917-922. [DOI: 10.1177/1129729820911225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Peripherally inserted central catheters are very common devices for short, medium and long-term therapies. Their performance is strictly dependent on the correct tip location, at the junction between the upper caval vein and the right atrium. It is very important to obtain an estimated measure of the catheter, in order to reach the cavo-atrial junction and optimize the catheter length. Estimated measures are often obtained using cutaneous landmarks. Objective: Evaluate the reliability of cutaneous landmark-based length estimation during catheter insertion. Identify any patient’s related factors that may affect cutaneous landmarks reliability. Methods: We used two distinct techniques and collected data about cutaneous landmark-based length estimation, electrocardiographic guided intravascular length, age, weight and height. We studied the reliability of possible correcting factors, balancing the error average by regression models, and we found and tested two different models of prediction. Results: A total number of 519 patients were studied. The average bias, between the two studied length assessment by cutaneous landmarks and electrocardiographic guided catheter length, were 3.77 ± 2.44 cm and 3.28 ± 2.57 cm, respectively. The analysed prediction models (deviance explained 43.5%, Akaike information criterion = 1313.67% and 43.4%, Akaike information criterion = 1313.92), fitted on the validation set, showed a root mean square error of 3.07 and 3.06. Conclusion: Landmark-based length estimation for preventive catheter length assessment seems to be unreliable, when associated with post-procedural tip location. They are useful for distal trimming catheters to optimize the ‘out of skin’ portion when associated with electrocardiographic tip location. Models identified for balancing bias are probably not useful.
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Affiliation(s)
- Stefano Elli
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
| | - Giacomo Bellani
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
- University of Milano-Bicocca, Milano, Italy
| | - Luigi Cannizzo
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
| | - Luciano Giannini
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
| | - Christian De Felippis
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
| | - Simona Vimercati
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
| | | | - Alberto Lucchini
- Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy
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Xiao AQ, Sun J, Zhu LH, Liao ZY, Shen P, Zhao LL, Latour JM. Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study. Eur J Pediatr 2020; 179:439-446. [PMID: 31788740 DOI: 10.1007/s00431-019-03524-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 12/19/2022]
Abstract
This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.
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Affiliation(s)
- Ai-Qing Xiao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Jing Sun
- Nursing school, Hunan University of Chinese Medicine, Changsha, Hunan Province, China.,Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Zhen-Yu Liao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Ping Shen
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Lin-Lin Zhao
- Division of Neonatal Medicine, Xiangtan Central Hospital, Xiangtan, Hunan Province, China
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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Liu C, Jiang D, Jin T, Chen C, Shi R, Liu L, Mao J, Gu L, Xu L, Meng A. Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients. J Vasc Access 2020; 21:732-737. [PMID: 32072851 DOI: 10.1177/1129729820904833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. METHODS A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. RESULTS A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was -15.83 ± 8.97 mm. The difference between the two positions was statistically significant (p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index (p = 0.009) and height (p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. CONCLUSION The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.
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Affiliation(s)
- Chunli Liu
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Dingbiao Jiang
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Tao Jin
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Chuanyin Chen
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Ruchun Shi
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Lagen Liu
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Jing Mao
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Lili Gu
- Department of Vascular Access Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Liyong Xu
- Department of General Surgery, Nanjing Agriculture University Hospital, Nanjing, P.R. China
| | - Aifeng Meng
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, P.R. China
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Xu H, Zhu X, Li J, Yao Y, Guo M, Yu T, Xiong X, Huang Z, Miao L, Lin D. Using sternal angle as anatomic landmark for right internal jugular vein catheterization in pediatrics. Acta Anaesthesiol Scand 2020; 64:188-192. [PMID: 31529467 DOI: 10.1111/aas.13474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many formulas based on the patient's height, weight and/or age exist to determine central venous catheter (CVC) depth in children. However, this information is unavailable in some emergency conditions. Therefore, direct methods should be developed to guide catheter position in children. METHODS Eighty patients aged 1-10 y were enrolled from July 2015 to August 2016 and seventy-five were completed; fifty were male, and twenty-five were female. The exclusion criteria were inability to identify the sternal angle or failure to use the right internal jugular vein approach. The catheter was inserted using the right internal jugular vein approach, the distance from the skin puncture point to the midpoint of the sternal angle plane was measured, and the catheter tip was positioned to this distance minus 1 cm. Chest radiography were performed for those children after catheter insertion. The relative position between the catheter tip and carina was confirmed and the longitudinal distance from the catheter tip to the carina was calculated on radiographic images, and related complications were recorded. RESULTS All catheter tips were above the carina, and the average distance from the catheter tip to the carina was 9.8 mm. No patients experienced serious complications. CONCLUSION The sternal angle is a useful and reliable anatomic landmark for guiding CVC position in children. Using this landmark, the catheter can be quickly and conveniently placed at a safety position in right internal jugular vein, especially in some emergency conditions.
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Affiliation(s)
- Hui Xu
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Xiaoqiu Zhu
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Jin Li
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Yiyi Yao
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Mingyan Guo
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Taihui Yu
- Department of Radiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Xilin Xiong
- Department of Pediatrics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Liping Miao
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Daowei Lin
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
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Yu X, Wang X, Fan L, Cao N, Yang F, Li J, Jiang H. Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study. Front Pediatr 2020; 8:570978. [PMID: 33134231 PMCID: PMC7562827 DOI: 10.3389/fped.2020.570978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position. Objective: To investigate the causes and preventive measures of ECC-related PE in neonates. Methods: This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated. Results: ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero (P < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site (P < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without (P < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively. Conclusion: ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiujun Li
- Department of Pediatrics, Plateau Medical Research Center of China Medical University, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Jiang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Yang L, Bing X, Song L, Na C, Minghong D, Annuo L. Intracavitary electrocardiogram guidance for placement of peripherally inserted central catheters in premature infants. Medicine (Baltimore) 2019; 98:e18368. [PMID: 31852143 PMCID: PMC6922499 DOI: 10.1097/md.0000000000018368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study evaluated the accuracy of intracavitary electrocardiogram (IC-ECG) guidance for placement of peripherally inserted central catheters (PICCs) in premature infants, relative to chest X-ray.Premature infants (n = 173) underwent placement of a PICC monitored by ECG, and a stable heart rhythm was shown. Changes in the P wave of the ECG reflected the position of the catheter tip, and a characterized P wave indicated the correct position. The P wave results were compared with a chest X-ray.P wave changes were observed in 157 (90.75%) of the premature infants on the ECG. Among them, the catheter tips of 148 (85.55%) and nine (5.20%) patients were in the correct and non-correct position, respectively, which was confirmed by chest X-ray. No characteristic P wave changes were observed in 16 (9.32%) patients on ECG, in which the catheter tips of eight (4.62%) patients each were in the correct and non-correct position, according to the chest X-ray. The accuracy of IC-ECG guidance for placement of the PICC was 90.17%. The PICC tip location results of the IC-ECGs were statistically similar to that of the chest X-rays.IC-ECG guidance is accurate for placement of PICC in premature infants, and provides an economical assessment without radiation.
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Affiliation(s)
- Lijuan Yang
- Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Xu Bing
- Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Luo Song
- Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Chen Na
- Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Dai Minghong
- Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Liu Annuo
- Nursing College of Anhui Medical University, Hefei
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Wang D, Niu F, Gao H, Yu M, Li Y, Xu L, Cao H, Wang L, Liu J, Ding X, Wang Y, Yu C, Li H, Yu K, Wang C. Influence of guide wire removal on tip location in peripherally inserted central catheters (PICCs): a retrospective cross-sectional study. BMJ Open 2019; 9:e027278. [PMID: 31676643 PMCID: PMC6830624 DOI: 10.1136/bmjopen-2018-027278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to identify the prevalence of peripherally inserted central catheter (PICC) malposition and the influence of guide wire removal on tip location in PICCs and determine whether related factors, including age, sex, side of insertion and brand of catheter, influence the PICC tip location. SETTING Single-centre research institute in China recruiting patients from the hospital. PARTICIPANTS A total of 837 adult patients with inserted PICCs were recruited from October 2016 to May 2017. INTERVENTIONS This was a cross-sectional study aiming to identify the prevalence of PICC malposition and the influence of guide wire removal on tip location in PICCs. A linear regression model and a variance of factorial design analysis were performed. The PICC tip location was documented on a postinsertion chest X-ray. Multivariable analyses were performed based on the following related factors: age, sex, side of insertion and brand of catheter. RESULTS The tip location moved a mean of 17.4 mm among the 837 included patients. The prevalence of PICC malposition was 83.6% (700/837), while 16.4% (137/837) of PICCs remained in correct location. The mean movement caused by guide wire removal without an adjusted tail end was (-1.95±26.90) mm. The difference between tail end adjustment movement and actual tip position movement in each PICC was (33.0±17.1) mm in type C, which was significantly higher than the findings for type A (12.8±13.3) mm and type B (12.9±12.7) mm. CONCLUSIONS PICC malposition is a frequent event. Different catheter brands were associated with different ranges of movement in tip location after guide wire removal. The age and sex of the patients and the insertion side did not influence the extent of movement.
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Affiliation(s)
- Dan Wang
- Anesthesiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fangfang Niu
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Huining Gao
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Mingkai Yu
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Yuhang Li
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
- Anesthesiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Liqun Xu
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Huizhi Cao
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Lili Wang
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Jinhua Liu
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Xue Ding
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Ying Wang
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Chen Yu
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Huiyan Li
- Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Kaijiang Yu
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
- Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Changsong Wang
- Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China
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Weber MD, Himebauch AS, Conlon T. Repositioning of malpositioned peripherally inserted central catheter lines with the use of intracavitary electrocardiogram: A pediatric case series. J Vasc Access 2019; 21:259-264. [PMID: 31364466 DOI: 10.1177/1129729819865812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs. CASE PRESENTATION A case series of four patients will be discussed. The first three patients had peripherally inserted central catheter tips that were initially appropriately positioned but had later peripherally inserted central catheter tip migration. The use of intracavitary electrocardiogram was able to confirm the appropriate repositioning of the peripherally inserted central catheters without the need for serial radiographs. The fourth patient had several central lines in place, which led to difficulty in identifying the peripherally inserted central catheter tip location. The use of intracavitary electrocardiogram confirmed proper positioning of his peripherally inserted central catheter tip when standard radiographs could not provide clarity. DISCUSSION Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.
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Affiliation(s)
- Mark D Weber
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA, USA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA, USA
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA, USA
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Weber MD, Eithun B, Himebauch AS, Conlon T. Cephalic peripherally inserted central catheter placement with retrograde basilic vein malposition. J Vasc Access 2019; 21:125-126. [PMID: 31232155 DOI: 10.1177/1129729819857025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mark D Weber
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin Eithun
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Katsoulas T, Kapritsou M, Alexandrou E, Bastaki M, Giannakopoulou M, Kiekkas P, Stafylarakis E, Konstantinou EA. Peripherally inserted central catheter ports: A vascular access specialist's systematic approach. JOURNAL OF VASCULAR NURSING 2019; 37:113-116. [PMID: 31155157 DOI: 10.1016/j.jvn.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 02/08/2023]
Abstract
Implanted ports are an important vascular access device for patients with malignancies requiring long-term chemotherapy. Peripherally placed ports are increasing in use as they are a safe, cost-effective alternative to chest-placed ports. Most peripheral ports can be placed bedside by specialist nurses in designated clinical areas rather than costly operating rooms or interventional radiology suites. Peripheral ports are considered less invasive compared with chest port placement because of reduced procedural risk. To enhance the success rate of peripheral port placement and minimize risks, we provide vascular access specialists with a systematic approach along with some technical advice tips and tricks to help avoid mechanical complications such as repeated puncture of the vein, excessive bleeding, thrombosis or skin dehiscence, as well as latent complications such as catheter migration and catheter-related blood stream infection.
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Affiliation(s)
- Theodoros Katsoulas
- Assistance Professor, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kapritsou
- Hellenic Anticancer Institute, "Saint Savvas" Hospital, Day Care Surgery Clinic "N. Kourkoulos", Athens, Greece
| | - Evan Alexandrou
- Centre for Applied Nursing Research, Western Sydney University, Sydney, Australia; Department of Intensive Care, Liverpool Hospital, Liverpool, Australia; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Australia
| | - Maria Bastaki
- General Hospital of Nikaias, Piraeus, Athens, Greece
| | - Margarita Giannakopoulou
- Professor, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kiekkas
- Department of Anesthesiology, General University Hospital of Patras, Patras, Greece
| | | | - Evangelos A Konstantinou
- Professor of Nursing Anesthesiology, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
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Yamamoto T, Schindler E. A new way to determine correct depth of central venous catheter insertion using a real-time ultrasound-guided insertion technique in pediatric patients. Paediatr Anaesth 2019; 29:368-376. [PMID: 30793433 DOI: 10.1111/pan.13614] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several formulae or methods are reported to predict the ideal central venous catheter insertion depth. However, they are complicated and often unsuitable in cases requiring rapid management. AIMS This study aimed to determine a simple and practical method to predict the ideal central venous catheter insertion depth after the real-time ultrasound-guided right internal jugular vein, or left or right supraclavicular approach in pediatric patients. METHOD Pediatric patients with congenital heart diseases who underwent cardiovascular surgery between July 2015 and February 2018 in the German Pediatric Heart Center Sankt Augustin were enrolled. Body height, body weight, patient age (months), and central venous catheter insertion depth were retrieved from the anesthesia records. Ideal central venous catheter insertion depth was calculated by measuring the distance between the level of the carina tracheae and the central venous catheter tip on the first postoperative chest radiograph. The relationships of body height, body weight, and patient age (months) to ideal central venous catheter insertion depth for the right internal jugular, left supraclavicular, and right supraclavicular approaches were investigated. RESULTS Body height was the best parameter, providing the best coefficients of determination as well as the simplest relationship. Based on analysis for ideal central venous catheter insertion depth for every 10-cm increase in body height, there was an ideal central venous catheter insertion depth for each body height, independent of the anesthesiologist's experience with the approach used. Whereas ideal central venous catheter insertion depths for the right internal jugular vein approach and the left supraclavicular approach showed no significant difference, ideal central venous catheter insertion depth for the right supraclavicular approach was significantly shorter than that of the other two approaches. CONCLUSION This study successfully determined a visually simple and practical bar graph to predict the ideal central venous catheter depth inserted using only the real-time ultrasound-guided insertion technique for the right internal jugular vein, left supraclavicular, and right supraclavicular approaches.
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Affiliation(s)
- Tomohiro Yamamoto
- Department of Pediatric Anesthesiology and Critical Care Medicine, German Pediatric Heart Center/Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Ehrenfried Schindler
- Department of Pediatric Anesthesiology and Critical Care Medicine, German Pediatric Heart Center/Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
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Qin KR, Nataraja RM, Pacilli M. Letter to the Editor. J Pediatr Surg 2019; 54:866. [PMID: 30651191 DOI: 10.1016/j.jpedsurg.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Kirby R Qin
- Department of Paediatric Surgery, Monash Children's Hospital, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Monash University, Melbourne, Australia.
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Liu G, Hou W, Zhou C, Yin Y, Lu S, Duan C, Li M, Toft ES, Zhang H. Meta-analysis of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement. J Vasc Access 2019; 20:577-582. [DOI: 10.1177/1129729819826028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background:Recently, intracavitary electrocardiogram technology has been applied to peripherally inserted central catheter placement and demonstrates many potential advantages. However, the tip positioning accuracy of intracavitary electrocardiogram technology compared to conventional X-ray method is unknown.Objective:We did a meta-analysis to compare the tip positioning accuracy between intracavitary electrocardiogram technology and conventional X-ray method.Data sources:We searched several databases, including Cochrane Library, PubMed, Web of science, and Embase. Additional studies were identified through hand searches of bibliographies and Internet searches. All human studies published in full text, abstract, or poster form were eligible for inclusion. Search terms included peripherally inserted central catheter, PICC, intracavitary electrocardiogram, IC-ECG, EKG, ECG, and catheter tip location.Study eligibility criteria:Only randomized controlled trials of using intracavitary electrocardiogram technology versus X-ray method for peripherally inserted central catheter placement were included. All studies included adult patients aged at least 18 years.Study appraisal and synthesis methods:Independent extraction of articles by two authors using predefined data fields, including study quality indicators. Of the 178 citations identified, 5 studies that included 1672 patients met the eligibility criteria. It was found that statistical heterogeneity existed among the various studies (I2 = 16%, p < 0.00001); therefore, the fixed effect model was used in the meta-analysis (p < 0.05). The meta-analysis compared the tip positioning accuracy between intracavitary electrocardiogram technology and X-ray method and showed that intracavitary electrocardiogram technology had a better positioning accuracy (odds ratio: 2.88, 95% confidence interval: 2.15–3.87, p < 0.0001).Limitations:Only five randomized trial met inclusion criteria, and the lack of an incomplete search led to the publication bias seen in these results.Conclusion:The intracavitary electrocardiogram method had a more favorable positioning accuracy versus traditional X-ray method for peripherally inserted central catheter placement in adult patients. The intracavitary electrocardiogram can be a promising technique to guide tip positioning of peripherally inserted central catheter.
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Affiliation(s)
- Guang Liu
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
| | - Wenbo Hou
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
| | - Chao Zhou
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
| | - Yuxia Yin
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
| | - Shoutao Lu
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
| | - Cuihai Duan
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
| | - Maoquan Li
- Tenth People’s Hospital of Tongji University, Shanghai, China
| | | | - Haijun Zhang
- National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China
- Tenth People’s Hospital of Tongji University, Shanghai, China
- Aalborg University, Alborg, Denmark
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Accuracy and Safety Study of Intracavitary Electrocardiographic Guidance for Peripherally Inserted Central Catheter Placement in Neonates. J Perinat Neonatal Nurs 2019; 33:89-95. [PMID: 30676468 DOI: 10.1097/jpn.0000000000000389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to investigate the accuracy and safety of intracavitary electrocardiogram (IC-ECG) guidance for the localization of peripherally inserted central catheter (PICC) in neonatal patients. A total of 160 neonatal patients were randomly assigned to receive either anthropometric measurement combined with IC-ECG guidance (n = 80) or conventional anatomical landmark guidance (n = 80) for PICC catheter tip positioning. The catheter tip position was confirmed by postinsertion radiograph and data were interpreted by independent radiologists. Subsequent catheter-related complications of neonates between 2 groups were also compared. The first-attempt target rate was 95.0% (95% confidence interval, 90.1%-99.9%) in IC-ECG-guided PICCs, significantly higher than 78.8% (95% confidence interval, 69.6%-87.9%) in the anatomical landmark guidance group (P < .05). In contrast, IC-ECG-guided PICCs provided a significantly lower overall incidence of the catheter-related complications (3.75%), compared with those guided by anatomical landmarks only (23.75%). Thus, combined use of anatomical landmark and IC-ECG guidance improved the first-attempt target rate of PICC placement and decreased catheter-related complications. These findings indicated a superior accuracy and safety of IC-ECG guidance to conventional anatomical landmark method in neonatal PICC practice.
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Calabrese M, Montini L, Arlotta G, La Greca A, Biasucci DG, Bevilacqua F, Antoniucci E, Scapigliati A, Cavaliere F, Pittiruti M. A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients. J Vasc Access 2018; 20:516-523. [DOI: 10.1177/1129729818819422] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction:The intracavitary electrocardiographic method is recommended for assessing the location of the tip of central venous catheter when there is an identifiable P wave. Previous reports suggested that intracavitary electrocardiographic method might also be applied to patients with atrial fibrillation, considering the so-called f waves as a surrogate of the P wave.Methods:We studied 18 atrial fibrillation patients requiring simultaneously a central venous catheter and a trans-esophageal echocardiography. An intracavitary electrocardiographic trace was recorded with the catheter tip in three different positions defined by trans-esophageal echocardiography imaging: in the superior vena cava, 2 cm above the cavo-atrial junction; at the cavo-atrial junction; and in the right atrium, 2 cm below the cavo-atrial junction. Three different criteria of measurement of the f wave pattern in the TQ tract were used: the mean height of f waves (method A); the height of the highest f wave (method B); the difference between the highest positive peak and the lowest negative peak (method C).Results:There were no complications. With the tip placed at the cavo-atrial junction, the mean value of the f waves was significantly higher than in the other two positions. All three methods were effective in discriminating the tip position at the cavo-atrial junction, though method B proved to be the most accurate.Conclusion:A modified intracavitary electrocardiographic technique can be safely used for detecting the location of the tip of central venous catheters in atrial fibrillation patients: the highest activity of the f waves is an accurate indicator of the location of the tip at the cavo-atrial junction.
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Affiliation(s)
- Maria Calabrese
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Montini
- Department of Intensive Care and Anesthesia, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Arlotta
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio La Greca
- Department of Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele G Biasucci
- Department of Intensive Care and Anesthesia, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bevilacqua
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrica Antoniucci
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Scapigliati
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Franco Cavaliere
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
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Li A, Jiao J, Zhang Y, Tian L, Miao J, Hao X, Sun Z, Sun Q. A randomized controlled study of bedside electrocardiograph-guided tip location technique & the traditional chest radiography tip location technique for peripherally inserted central venous catheter in cancer patients. Indian J Med Res 2018; 147:477-483. [PMID: 30082572 PMCID: PMC6094514 DOI: 10.4103/ijmr.ijmr_1120_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background & objectives: The peripherally inserted central catheter (PICC) has the advantages of higher safety, lower infection rate and longer retention time than peripherally inserted catheter. This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique. Methods: Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and after the procedure; medical cost and incidence of complications at one week, three months and six months after PICC insertion. Results: Accurate tip location was achieved in 99.30 per cent in the ECG test group vs 92.30 per cent in the control group (P <0.001). At 24 h after the procedure, the anxiety level was significantly lower in the ECG test group. The presence of thrombogenesis was significantly lower in the ECG test group at both three months and six months after the procedure (P=0.04 and P=0.03, respectively). Interpretation & conclusions: The ECG-guided PICC tip location technique was accurate and caused fewer procedure-related complications and less anxiety in patients compared to chest radiography tip location technique. Radiographic confirmation of PICC tip position may not be needed when ECG guidance is used and thus it can help avoid radiation exposure.
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Affiliation(s)
- AiMin Li
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - JianGuo Jiao
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ying Zhang
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Li Tian
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - JinHong Miao
- Comprehensive Medical Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - XiaoLi Hao
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - ZhenChang Sun
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - QiaoZhi Sun
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Pittiruti M, Scoppettuolo G, Dolcetti L, Emoli A. Clinical use of Sherlock-3CG® for positioning peripherally inserted central catheters. J Vasc Access 2018; 20:356-361. [DOI: 10.1177/1129729818805957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, “A. Gemelli” Hospital Foundation, Catholic University, Rome, Italy
| | - Giancarlo Scoppettuolo
- Department of Infective Diseases, “A. Gemelli” Hospital Foundation, Catholic University, Rome, Italy
| | - Laura Dolcetti
- Department of Infective Diseases, “A. Gemelli” Hospital Foundation, Catholic University, Rome, Italy
| | - Alessandro Emoli
- Department of Oncology, “A. Gemelli” Hospital Foundation, Catholic University, Rome, Italy
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Gao Y, Liu Y, Zhang H, Fang F, Song L. The safety and accuracy of ECG-guided PICC tip position verification applied in patients with atrial fibrillation. Ther Clin Risk Manag 2018; 14:1075-1081. [PMID: 29922068 PMCID: PMC5995413 DOI: 10.2147/tcrm.s156468] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Tip position verification of peripherally inserted central catheters (PICCs) is essential to the use of the catheter. Postprocedural chest X-ray as the “gold standard” practice for PICC tip confirmation can lead to a significant delay for patient IV therapy, cost more, and lead to radiation exposure for both patients and staffs. Intracavitary electrocardiogram (IC-ECG)-guided PICC placement which provides real-time tip confirmation during the insertion procedure has been widely used. However, safety and accuracy of ECG for abnormal surface ECG patients, such as patients with atrial fibrillation (AF), have not been reported. Objective To determine the safety and accuracy of IC-ECG technique for PICC tip position verification among the patients with AF. Patients and methods A prospective cohort study was conducted in a teaching and tertiary referral hospital with more than 3,600 beds in Qingdao, People’s Republic of China. Adult patients with diagnosis of AF who need a PICC for infusion from June 2015 to May 2017 were enrolled in the study. For every included patient with AF, ECG was used to detect the PICC tip position during catheterization and X-ray was done to confirm the tip position as the “gold standard” after PICC insertion. The effectiveness and accuracy of ECG-guided catheter tip positioning and chest X-ray confirmation were compared. Results Totally, 118 AF patients with 118 PICCs were enrolled (58 male and 60 female, age range 50–89 years old). There was no catheterization-related complication. When the catheter entered the lower 1/3 of superior vena cava, the amplitude of f wave reached the maximum. There was no statistical difference between X-ray PICC tip position verification and IC-ECG PICC tip position verification among patients with AF (χ2=1.31, P=0.232). Utilizing the cutoff point of f wave change ≥0.5 cm, a sensitivity of 0.94, a specificity of 0.71, a positive predictive value of 0.98, and a negative predictive value of 0.42 were observed. The area under the receiver operating characteristic curve was 0.909 (95% CI: 0.810–1.000). Conclusion The ECG-guided technique represents a safe and accurate technique to verify the position of PICC tip in patients with AF and could potentially remove the requirement for postprocedural chest X-ray among the patients with AF.
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Affiliation(s)
- Yufang Gao
- Hospital Management Office, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Yuxiu Liu
- Hospital Management Office, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.,Department of Community Nursing, School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Hui Zhang
- Hospital Management Office, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Fang Fang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Lei Song
- Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
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Ling QY, Chen H, Tang M, Qu Y, Tang BZ. [Efficiency of electrocardiogram monitor for positioning the catheter tip in peripherally inserted central catheter placement in neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:363-367. [PMID: 29764571 PMCID: PMC7389060 DOI: 10.7499/j.issn.1008-8830.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central catheter (PICC) in neonates. METHODS A total of 160 neonates who were admitted to the neonatal intensive care unit (NICU) from January 2015 to December 2017 and underwent the PICC placement via the veins of upper extremity were enrolled. They were randomly divided into an observation group and a control group, with 80 neonates in each group. The neonates in the control group were given body surface measurement and postoperative X-ray localization, while those in the observation group were given body surface measurement, ECG localization, and postoperative X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement. RESULTS There were no significant differences between the two groups in sex composition, gestational age, age in days at the time of PICC placement, disease type, and site of puncture (P>0.05). Compared with the control group, the observation group had a significantly higher one-time success rate of PICC placement (95% vs 79%; P<0.05) and a significantly shorter time spent on PICC placement (P<0.05). Localization under an ECG monitor during PICC placement had a sensitivity of 97% and a specificity of 100%. CONCLUSIONS During the PICC placement in neonates, the use of ECG monitor to determine the position of catheter tip can improve the one-time success rate of placement and reduce the time spent on placement.
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Affiliation(s)
- Qi-Ying Ling
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital/University of Electronic Science and Technology of China, Chengdu 610072, China.
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Mastroianni R, Capasso A, Ausanio G. The intracavitary electrocardiography method for tip location of jugular internal vein access device in infants of less than 5 kg: A pilot study. J Vasc Access 2018; 19:639-643. [DOI: 10.1177/1129729818769028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This is a prospective observational study conducted by neonatologists in neonatal intensive care unit from Sant’Anna and San Sebastiano Hospital, Caserta, Italy. The objective of the study is to verify the feasibility of intracavitary electrocardiography method for tip location of central venous access device in infants of less than 5 kg and evaluate the accuracy of the method in comparison with post-procedural echocardiographical verification of the tip position. Patients and methods: We enrolled 27 patients weighted between 0.660 and 5 kg, requiring central vascular access. Ultrasound-guided jugular internal vein access was used and after cannulation, we applied the intracavitary electrocardiography for tip location as well as post-procedural echocardiography. Results: No significant complication related to intracavitary electrocardiography occurred in the studied infants. The increase in P wave on intracavitary electrocardiography was detected in all cases (27/27). In only one case (false positive), the catheter had the tip out of cavoatrial junction–target zone (to post-procedural echocardiography). Conclusion: The intracavitary electrocardiography method for tip location of central venous access device is safe and accurate in infants, as demonstrated by post-procedural comparative echocardiographic controls. As an alternative to echocardiography, not always achievable, the diffusion of intracavitary electrocardiography method could reduce X-ray exposition and complications of a malpositioned tip.
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Affiliation(s)
- Rossella Mastroianni
- Neonatal Intensive Care Unit, Sant’Anna and San Sebastiano Hospital, Caserta, Italy
| | - Antonella Capasso
- Neonatal Intensive Care Unit, Sant’Anna and San Sebastiano Hospital, Caserta, Italy
| | - Gaetano Ausanio
- Neonatal Intensive Care Unit, Sant’Anna and San Sebastiano Hospital, Caserta, Italy
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