Weber Mark D, Himebauch Adam S, Conlon Thomas
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA, USA.
J Vasc Access. 2020 Mar;21(2):259-264. doi: 10.1177/1129729819865812. Epub 2019 Jul 31.
Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs.
A case series of four patients will be discussed. The first three patients had peripherally inserted central catheter tips that were initially appropriately positioned but had later peripherally inserted central catheter tip migration. The use of intracavitary electrocardiogram was able to confirm the appropriate repositioning of the peripherally inserted central catheters without the need for serial radiographs. The fourth patient had several central lines in place, which led to difficulty in identifying the peripherally inserted central catheter tip location. The use of intracavitary electrocardiogram confirmed proper positioning of his peripherally inserted central catheter tip when standard radiographs could not provide clarity.
Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.
外周静脉穿刺中心静脉导管（PICC）尖端移位是一种在新生儿、儿童和成人患者中较少发生的情况。我们讨论一种利用心腔内心电图来帮助确认PICC尖端重新定位是否正确的新技术，从而减少对系列X线片的需求。
将讨论一个包含四名患者的病例系列。前三例患者的PICC尖端最初位置合适，但后来发生了PICC尖端移位。使用心腔内心电图能够确认PICC的重新定位正确，而无需系列X线片。第四例患者有多根中心静脉导管，导致难以确定PICC尖端的位置。当标准X线片无法提供清晰图像时，使用心腔内心电图确认了其PICC尖端的正确定位。
已经发表了几种将移位的PICC尖端重新定位到上腔静脉/右心房交界处的方法。这些重新定位技术通常需要荧光透视引导或确认性X线片来评估PICC尖端的合适位置。有时，在尖端成功重新定位之前可能需要几张X线片。在心腔内心电图的这种新应用可以在需要重新定位PICC尖端时帮助尽量减少X线片的使用。
