Albertini Fabrizio, Struglia Manuela, Faraone Vincenzo, Fioravanti Roberto, Boursier Niutta Stefano
Unità di Medicina Interna e Ambulatorio Infermieristico di Accessi Vascolari, Polo Ospedaliero Mazzoni, Area Vasta 5, ASUR Marche, Ascoli Piceno, Italy -
Unità di Medicina Interna e Ambulatorio Infermieristico di Accessi Vascolari, Polo Ospedaliero Mazzoni, Area Vasta 5, ASUR Marche, Ascoli Piceno, Italy.
Minerva Cardioangiol. 2019 Jun;67(3):207-213. doi: 10.23736/S0026-4725.19.04915-6.
The peripherally inserted central catheters (PICCs) are third generation silicone or polyurethane catheters, used as venous accesses for long- and medium-term care, and recommended in therapies that require venous access for more than six days. Current implantation methods recommend the radiological method, using standard chest RX in antero-posterior projection, as a method of assessing the correct positioning of the catheter tip. The observational study evaluated the effectiveness in terms of reliability of the intracavitary tip location system (ITLS) method, better known as the ECG method, for the correct positioning of the catheter tip in patients with atrial fibrillation (AFIB); the method exploits the recording of the electrical potential produced by the f waves, expression of the fibrillation of the atrium typical in patients with this disease, the measurement is based on the calculation of the peak-to-peak value of the f waves. They were implanted using this method 101 subjects with previous determination of anthropometric measurement, according to the rule of Peres modified according to Pittiruti, and then subjected to standard thoracic RX in projection antero-posterior and latero-lateral. Our study shows that 97% of the patients implanted with this method at radiological control had the PICC correctly positioned, at an average distance from the hull of 44.9mm; 100% of the patients did not present complications in either the short or medium term. The analysis of the data also shows that the anthropometric evaluations, carried out with the Peres method, corresponded to the correct radiological positioning of the catheter, evaluated with the hull method, only in 45.5% of cases. Our study tends to demonstrate that the ECG-ITLS method, used as a method of intra-procedural control of PICC-type CVC positioning, in patients with atrial fibrillation, has greater reliability than that of anthropometric measurement and equivalent to radiological measurement, but has less chance of incurring in error of reading or projection.
外周静脉穿刺中心静脉导管（PICC）是第三代硅胶或聚氨酯导管，用作中长期护理的静脉通路，适用于需要静脉通路超过6天的治疗。目前的植入方法推荐采用放射学方法，即使用标准胸部前后位X线片来评估导管尖端的正确位置。这项观察性研究评估了腔内尖端定位系统（ITLS）方法（更广为人知的是心电图方法）在心房颤动（AFIB）患者中导管尖端正确定位的可靠性方面的有效性；该方法利用记录f波产生的电位，f波是这种疾病患者典型的心房颤动表现，测量基于f波峰峰值的计算。根据经皮蒂鲁蒂修改的佩雷斯规则，对101名先前已测定人体测量数据的受试者采用该方法进行植入，然后进行标准胸部前后位和侧位X线片检查。我们的研究表明，在放射学检查中采用该方法植入的患者中，97%的PICC定位正确，导管尖端距隆突的平均距离为44.9mm；100%的患者在短期或中期均未出现并发症。数据分析还表明，采用佩雷斯方法进行的人体测量评估，与采用隆突方法评估的导管正确放射学定位仅在45.5%的病例中相符。我们的研究倾向于证明，在心房颤动患者中，作为PICC型中心静脉导管定位术中控制方法使用的心电图-ITLS方法，比人体测量具有更高的可靠性，与放射学测量相当，但出现读数或投照错误的可能性较小。
