Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases

Lilan He; Weiju Chen; Meng Zhang; Na Lin; Wenyan Yang

doi:doi:10.11648/j.ajns.20190804.13

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Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases

Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang

Published in American Journal of Nursing Science (Volume 8, Issue 4)

Received: 5 April 2019 Accepted: 11 May 2019 Published: 4 June 2019

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Abstract

A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants（207 male and 120 female）were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the ﬁrst attempt, 5 were incorrectly identiﬁed to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superﬁcial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.

Published in	American Journal of Nursing Science (Volume 8, Issue 4)
DOI	10.11648/j.ajns.20190804.13
Page(s)	142-144
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Intracavitary ECG, Malposition, PICC, Tip Placement, Premature Infants, Radiography

References

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[2]	Oliver G, Jones M. ECG-based PICC tip verification system: an evaluation 5 years on. [J]. British Journal of Nursing, 2016, 25 (19): S4-S10.
[3]	Walker G, Chan R J, Alexandrou E, et al. Effectiveness of electrocardiographic guidance in CVAD tip placement [J]. British Journal of Nursing, 2015, 24 (14): S4, S6, S8.
[4]	Perin G, Scarpa M G. Defining central venous line position in children: tips for the tip [J]. Journal of Vascular Access, 2016, 16 (2): 0-0.
[5]	Rossetti F, Pittiruti M, Lamperti M, et al. The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study. [J]. Journal of Vascular Access, 2014, 13 (3): 137-143.
[6]	Neubauer A P. Central venous placement of silastic catheters by a recording of an intravascular ECG--a prospective study in 50 premature infants weighing less than 1000 g. [J]. Klinische Padiatrie, 1991, 203 (3): 146-148.
[7]	Neubauer A P. Percutaneous central i.v. access in the neonate: experience with 535 silastic catheters [J]. Acta Paediatrica, 2010, 84 (7): 756-760.
[8]	Weber F, Buitenhuis M, Lequin M H. Determination of the optimal length of insertion of central venous catheters in pediatric patients by endovascular ECG [J]. Minerva Anestesiologica, 2013, 79 (4): 379-84.
[9]	Perin G. PICC placement in the neonate [J]. New England Journal of Medicine, 2014, 370 (22): 2153.
[10]	Sharpe E, Kuhn L, Ratz D, et al. Neonatal Peripherally Inserted Central Catheter Practices and Providers: Results From the Neonatal PICC1 Survey [J]. Advances in Neonatal Care, 2016, 17: 1.
[11]	Gemma O, Matt J. ECG or X-ray as the 'gold standard' for establishing PICC-tip location? [J]. British Journal of Nursing, 2014, 19: 10-6.
[12]	Baldinelli F, Capozzoli G, Pedrazzoli R, Marzano N. Evaluation of the correct position of peripherally inserted central catheters: anatomical landmark vs. electrocardiographic technique [J]. Journal of Vascular Access, 2015; 16 (5): 394–398.
[13]	Capasso A, Mastroianni R, Passariello A, et al. The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study [J]. The Journal of Vascular Access, 2018:112972981876129.
[14]	Zhou L, Xu H, Liang J, et al. Effectiveness of Intracavitary Electrocardiogram Guidance in Peripherally Inserted Central Catheter Tip Placement in Neonates [J]. Journal of Perinatal & Neonatal Nursing, 2017, 31 (4).
[15]	Zhou L, Xu H, Xu M, et al. An accuracy study of the Intracavitary Electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates [J]. Open Med, 2017, 12 (1): 125-130.

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APA Style

Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang. (2019). Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. American Journal of Nursing Science, 8(4), 142-144. https://doi.org/10.11648/j.ajns.20190804.13

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ACS Style

Lilan He; Weiju Chen; Meng Zhang; Na Lin; Wenyan Yang. Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. Am. J. Nurs. Sci. 2019, 8(4), 142-144. doi: 10.11648/j.ajns.20190804.13

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AMA Style

Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang. Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. Am J Nurs Sci. 2019;8(4):142-144. doi: 10.11648/j.ajns.20190804.13

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@article{10.11648/j.ajns.20190804.13,
  author = {Lilan He and Weiju Chen and Meng Zhang and Na Lin and Wenyan Yang},
  title = {Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases},
  journal = {American Journal of Nursing Science},
  volume = {8},
  number = {4},
  pages = {142-144},
  doi = {10.11648/j.ajns.20190804.13},
  url = {https://doi.org/10.11648/j.ajns.20190804.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20190804.13},
  abstract = {A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants（207 male and 120 female）were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the ﬁrst attempt, 5 were incorrectly identiﬁed to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superﬁcial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.},
 year = {2019}
}

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TY - JOUR
T1 - Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases
AU - Lilan He
AU - Weiju Chen
AU - Meng Zhang
AU - Na Lin
AU - Wenyan Yang
Y1 - 2019/06/04
PY - 2019
N1 - https://doi.org/10.11648/j.ajns.20190804.13
DO - 10.11648/j.ajns.20190804.13
T2 - American Journal of Nursing Science
JF - American Journal of Nursing Science
JO - American Journal of Nursing Science
SP - 142
EP - 144
PB - Science Publishing Group
SN - 2328-5753
UR - https://doi.org/10.11648/j.ajns.20190804.13
AB - A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants（207 male and 120 female）were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the ﬁrst attempt, 5 were incorrectly identiﬁed to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superﬁcial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.
VL - 8
IS - 4
ER -

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Author Information

Lilan He

Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
Weiju Chen

Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
Meng Zhang

Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
Na Lin

Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
Wenyan Yang

Neonatal Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

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APA Style

Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang. (2019). Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. American Journal of Nursing Science, 8(4), 142-144. https://doi.org/10.11648/j.ajns.20190804.13

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ACS Style

Lilan He; Weiju Chen; Meng Zhang; Na Lin; Wenyan Yang. Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. Am. J. Nurs. Sci. 2019, 8(4), 142-144. doi: 10.11648/j.ajns.20190804.13

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AMA Style

Lilan He, Weiju Chen, Meng Zhang, Na Lin, Wenyan Yang. Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases. Am J Nurs Sci. 2019;8(4):142-144. doi: 10.11648/j.ajns.20190804.13

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@article{10.11648/j.ajns.20190804.13,
  author = {Lilan He and Weiju Chen and Meng Zhang and Na Lin and Wenyan Yang},
  title = {Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases},
  journal = {American Journal of Nursing Science},
  volume = {8},
  number = {4},
  pages = {142-144},
  doi = {10.11648/j.ajns.20190804.13},
  url = {https://doi.org/10.11648/j.ajns.20190804.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20190804.13},
  abstract = {A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks’ gestational age at PICC insertion was recorded. 327preterm infants（207 male and 120 female）were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the ﬁrst attempt, 5 were incorrectly identiﬁed to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superﬁcial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.},
 year = {2019}
}

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