Yu Xinying, Wang Xuejun, Fan Ling, Cao Na, Yang Fan, Li Jiujun, Jiang Hong
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China.
Front Pediatr. 2020 Oct 2;8:570978. doi: 10.3389/fped.2020.570978. eCollection 2020.
Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position. To investigate the causes and preventive measures of ECC-related PE in neonates. This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated. ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero ( < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site ( < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without ( < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively. ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.
尽管经皮腔静脉导管（ECCs）在新生儿长期肠外营养和长期药物给药的静脉通路中被常规使用，但ECC的使用可能与罕见但危及生命的急性事件相关，如胸腔积液（PE）。识别并将ECC尖端维持在中心位置对于预防并发症很重要。最近，腔内心电图（IC-ECG）已被开发用于实时监测和验证ECC尖端位置。为了研究新生儿ECC相关PE的原因及预防措施。这项前瞻性队列研究于2013年1月至2017年12月进行。我们观察并分析了ECC相关PE的临床特征和原因。2017年1月至12月，所有ECC均在IC-ECG引导下进行。分析了引入IC-ECG前后ECC相关PE的发生率和首次尝试成功率。此外，还评估了IC-ECG的敏感性和特异性。14例婴儿被诊断为ECC相关PE。3例导管位置不当；在其他11例中，导管插入时位于中心位置，但在发生PE时已迁移至非中心位置。引入IC-ECG后，PE的发生率为零（<0.05）。选择下肢静脉作为插入部位时，ECC相关PE的发生率较低（<0.05）。IC-ECG引导ECC放置组的首次尝试成功率明显高于无引导组（<0.05）。IC-ECG的敏感性和特异性分别为97.9%和84.6%。ECC相关PE可能与导管尖端的原发性位置不当或迁移有关。IC-ECG有助于检测导管尖端的位置不当和迁移，并提高首次尝试成功率。选择下肢插入部位可能有助于降低ECC相关PE的发生率。在新生儿中，IC-ECG是一种可靠的ECC定位方法，具有较高的敏感性和特异性。
