Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters.
BACKGROUND
Correct positioning of peripherally inserted central catheters (PICCs) is essential to avoid complications. We evaluated intravenous electrocardiogram (ECG) recordings during PICC placement to assess the effectiveness of this guidance technique to reduce complications resulting from incorrect catheter placement.


METHODS
Six patients undergoing PowerPICC catheter insertion were included in this pilot study. Venography through the PICC was performed to identify the superior vena cava-right atrial (SVC-RA) junction. Unipolar ECG recordings from the catheter stylet measured P-wave changes during PICC insertion.


RESULTS
The peak P-wave amplitude was highest at the SVC-RA junction. With catheter insertion into the RA, P-wave amplitude decreased and eventually became negative. With catheter withdrawal into the SVC, P-wave amplitude decreased.


CONCLUSIONS
P-wave amplitude was highest when the PICC catheter was in the optimal location at the SVC-RA junction. Intravenous ECG monitoring during PICC insertion seems to be a promising technique to guide catheter positioning.
Smith
Brigham
B
Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
Neuharth
Renée M
RM
Hendrix
Mary Ann
MA
McDonnall
Daniel
D
Michaels
Andrew D
AD
D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*