title: Accuracy of Intravenous Electrocardiography Confirmation of Peripherally Inserted Central Catheter for Parenteral Nutrition.
abstract: BACKGROUND
  Parenteral nutrition (PN) is a life-saving therapy for patients with intestinal failure. Safe delivery of hyperosmotic solution requires a central venous catheter (CVC) with tip in the lower superior vena cava (SVC) or at the SVC-right atrium (RA) junction. To reduce cost and delay in use of CVC, new techniques such as intravascular electrocardiogram (ECG) are being used for tip confirmation in place of chest x-ray (CXR). The present study assessed for accuracy of ECG confirmation in home PN (HPN).
  
  
  METHODS
  Records for all patients consulted for HPN from December 17, 2014, to June 16, 2015, were reviewed for patient demographics, diagnosis leading to HPN initiation, and ECG and CXR confirmation. CXRs were subsequently reviewed by a radiologist to reassess location of the CVC tip and identify those that should be adjusted.
  
  
  RESULTS
  Seventy-three patients were eligible, and after assessment for research authorization and postplacement CXR, 17 patients (30% male) with an age of 54 ± 14 years were reviewed. In all patients, postplacement intravascular ECG reading stated tip in the SVC. However, based on CXR, the location of the catheter tip was satisfactory (low SVC or SVC-RA junction) in 10 of 17 patients (59%).
  
  
  CONCLUSIONS
  Due to the high osmolality of PN, CVC tip location is of paramount importance. After radiology review of CXR, we noted that 7 of 17 (41%) peripherally inserted central catheter lines were in an unsatisfactory position despite ECG confirmation. With current data available, intravenous ECG confirmation should not be used as the sole source of tip confirmation in patients receiving HPN.
authors: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA mundi.manpreet@mayo.edu.
authors: Manpreet S
authors: MS
authors: Mundi
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA Department of Family Medicine, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA.
authors: Jithinraj
authors: J
authors: Edakkanambeth Varayil
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Megan T
authors: MT
authors: McMahon
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Akiko
authors: A
authors: Okano
authors: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
authors: Nishanth
authors: N
authors: Vallumsetla
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Sara L
authors: SL
authors: Bonnes
authors: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors: James C
authors: JC
authors: Andrews
authors: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Kentucky.
authors: Ryan T
authors: RT
authors: Hurt
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D062905:Central Venous Catheters; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: central venous catheters; electrocardiography; home parenteral nutrition; nutritional support; parenteral nutrition