Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Vasc Access. 2022 Jan;23(1):166-170. doi: 10.1177/1129729820982864. Epub 2020 Dec 25.
Femorally inserted central catheters (FICCs) are frequently required for central access in children. Ultrasound can accurately locate the catheter tip in most cases and its use is increasing in clinical vascular access practice. In patients with poor acoustic windows, intracavitary electrocardiogram (IC-ECG) is an alternative to ultrasound-guidance for FICC positioning. A case series of three patients demonstrate methods of FICC positioning in children. The first patient had excellent acoustic windows and ultrasound-guided FICC positioning is described in conjunction with IC-ECG measurements. The following two patients had poor acoustic windows, thus IC-ECG guided FICC tip position. The use of FICCs in children has increased in recent years. Ultrasound has emerged as a reliable method of assessing FICC tip location. IC-ECG is an accurate and complementary method of assessing FICC tip location, but can be a primary method when ultrasound is not available or cannot directly visualize the catheter. IC-ECG P-wave characteristics identify optimal tip position at the inferior cavoatrial junction and are different from characteristics at the superior cavoatrial junction.
股静脉内置中心导管（FICCs）常用于儿童的中心置管。在大多数情况下，超声可准确定位导管尖端，其在临床血管通路实践中的应用正在增加。对于声窗不佳的患者，心腔内心电图（IC-ECG）是超声引导 FICC 定位的替代方法。三例患者的病例系列展示了儿童 FICC 定位的方法。第一例患者声窗良好，描述了超声引导 FICC 定位并结合 IC-ECG 测量。以下两例患者声窗较差，因此采用 IC-ECG 引导 FICC 尖端位置。近年来，儿童 FICCs 的使用有所增加。超声已成为评估 FICC 尖端位置的可靠方法。IC-ECG 是评估 FICC 尖端位置的准确且互补的方法，但在无法使用超声或无法直接可视化导管时，它可以作为主要方法。IC-ECG P 波特征可确定下腔静脉与心房交界处的最佳尖端位置，与上腔静脉与心房交界处的特征不同。
