title: Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Brigham
authors.initials: B
authors.lastname: Smith
authors.forename: Renée M
authors.initials: RM
authors.lastname: Neuharth
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Hendrix
authors.forename: Daniel
authors.initials: D
authors.lastname: McDonnall
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
mesh_terms: 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*