Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Bejing), Peking University Cancer Hospital & Institute, Beijing, China.
Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Bejing), Peking University Cancer Hospital & Institute, Beijing, China.
Ann Palliat Med. 2021 Oct;10(10):10228-10235. doi: 10.21037/apm-21-1893. Epub 2021 Aug 24.
This study aimed to compare the tip location of peripherally inserted central catheter (PICC) under two forward P-wave amplitudes (P-wave amplitude is the autonomous peak or P-wave amplitude is 50-80% of the QRS main wave) by intracavitary electrocardiogram (IC-EKG) to determine the PICC tip in optimal location thus avoiding catheter-related complications.
The data of 300 cancer patients with PICC insertion were collected retrospectively. For the observation group, the position of the catheter tip was left at the level when P wave amplitude was its autonomous peak (168 patients catheterized in 2018). While for the control group, the catheter tip was left at the level when the P wave amplitude was 50-80% of the QRS main wave (132 patients catheterized in 2017). Both groups of patients underwent the chest X-ray examination (CXR) after catheterization. The total compliance rate [PICC tip was located in the lower third of the Superior Vena Cava (SVC) and the Cavo-Atrial Junction (CAJ)], the optimal position compliance rate (PICC tip was located in the CAJ), and the incidence of the catheter tip malposition were compared between the two groups. The complications after catheterization including arrhythmia after catheterization within 24 hours, catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days were also compared.
There was no difference in the total compliance rate of PICC tip position and the incidence of the catheter malposition in the two groups (P>0.05). But the optimal position compliance rate of the observation group was higher than that of the control group (P<0.05). There was no difference in the incidence of arrhythmia after catheterization within 24 hours of the two groups (P>0.05). The incidence of catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days in the observation group was lower than those in the control group (P<0.05).
The PICC tip position at the autonomous peak of the P wave is significantly better than that at the P wave amplitude being 50-80% of the QRS main wave under the IC-EKG guidance for PICC insertion.
本研究旨在通过心腔内心电图（IC-EKG）比较两种正向 P 波幅度（P 波幅度是自主峰值或 P 波幅度是 QRS 主波的 50-80%）下经外周静脉置入中心静脉导管（PICC）的尖端位置，以确定 PICC 尖端的最佳位置，从而避免导管相关并发症。
回顾性收集 300 例 PICC 置管癌症患者的资料。观察组导管尖端位置留置在 P 波幅度为自主峰值时（2018 年置管 168 例）。而对照组导管尖端位置留置在 P 波幅度为 QRS 主波的 50-80%时（2017 年置管 132 例）。两组患者均在行导管置管后进行胸部 X 线检查（CXR）。比较两组患者的总顺应率[PICC 尖端位于上腔静脉（SVC）的下三分之一和腔静脉心房交界处（CAJ）]、最佳位置顺应率（PICC 尖端位于 CAJ）和导管尖端错位发生率。比较两组患者导管置管后并发症，包括导管置管后 24 小时内心律失常、导管相关性血栓形成、导管功能障碍和导管感染 90 天内的发生率。
两组患者 PICC 尖端位置总顺应率和导管错位发生率差异无统计学意义（P>0.05）。但观察组的最佳位置顺应率高于对照组（P<0.05）。两组患者导管置管后 24 小时内心律失常发生率差异无统计学意义（P>0.05）。观察组导管相关性血栓形成、导管功能障碍和导管感染发生率低于对照组（P<0.05）。
在 IC-EKG 引导下，PICC 尖端位置在 P 波自主峰值时明显优于 P 波幅度为 QRS 主波的 50-80%时。
