Zhou Lianjuan, Xu Hongzhen, Liang Jianfeng, Xu Meifang, Yu Jun
Departments of Nursing (Mss Zhou, Xu, and Yu); and Medical Statistics (Mr Liang), Children's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
J Perinat Neonatal Nurs. 2017 Oct/Dec;31(4):326-331. doi: 10.1097/JPN.0000000000000264.
Correct tip location is crucial for a peripherally inserted central catheter (PICC) to maximize the effects of central venous infusion. However, it is difficult to place the tip in a correct location in neonates because of the unreliable estimated length by surface landmark. Therefore, we evaluated the feasibility and safety of an improved intracavitary electrocardiogram (IC-ECG) technique in guiding PICC placement in neonates based on the ratios of P/R wave amplitudes on IC-ECG. The results showed that all of the 32 neonates whose PICCs had been successfully placed and correct tip position verified by chest radiography acquired qualified P wave on IC-ECG. The average ratio of P/R wave amplitude was 0.6 ± 0.1, with a range of 0.4 to 0.8. The 49 neonates who received IC-ECG-guided PICC catheterization showed higher success rates of correct PICC tip position on the first attempt than traditional, predetermined length estimation on surface landmark (93.9% vs 62.5%, χ = 18.01, P < .001). No significant complications occurred in the studied neonates. Based on these findings, IC-ECG-guided tip placement appears to be a promising approach in improving the success rate of tip location when placing a PICC in neonates.
正确的尖端位置对于外周静脉穿刺中心静脉导管（PICC）以最大化中心静脉输液效果至关重要。然而，由于通过体表标志估计的长度不可靠，在新生儿中将尖端放置在正确位置很困难。因此，我们基于心腔内心电图（IC-ECG）上P波与R波振幅的比值，评估了一种改进的IC-ECG技术在指导新生儿PICC置管中的可行性和安全性。结果显示，所有32例PICC成功置入且经胸部X线证实尖端位置正确的新生儿，在IC-ECG上均获得了合格的P波。P波与R波振幅的平均比值为0.6±0.1，范围为0.4至0.8。49例接受IC-ECG引导下PICC置管的新生儿，首次尝试时PICC尖端位置正确的成功率高于传统的基于体表标志的预定长度估计法（93.9%对62.5%，χ=18.01，P<.001）。研究的新生儿中未发生明显并发症。基于这些发现，IC-ECG引导下的尖端放置似乎是一种有前景的方法，可提高新生儿PICC置管时尖端定位的成功率。
