Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang, China.
Department of Central Venous Catheter Clinic, Shijiazhuang People's Hospital, Shijiazhuang, China.
Ann Noninvasive Electrocardiol. 2022 May;27(3):e12931. doi: 10.1111/anec.12931. Epub 2022 Feb 17.
To observe the changes of F waves on electrocardiograms (ECGs) in patients with persistent atrial fibrillation during the insertion of a peripherally inserted central catheter (PICC), and to analyze the application effect of the ECG method (through F wave changes) for guiding PICC tip positioning.
Seventy-two patients who met the inclusion criteria and needed a PICC catheter were selected as the research subjects. We observed waveforms in the ECGs when the tip of the catheter reached a predetermined position. The chest X-ray results were used as the gold standard to calculate the sensitivity and specificity, and judge the safety and accuracy of ECG-guided PICC tip positioning in patients with atrial fibrillation.
Of the 72 patients, there was no significant difference between the ECG method and chest X-ray results (χ = 0.2, p > 0.05). Sixty-one patients had F wave changes on ECG and 10 had no obvious changes (X-ray results confirmed that five patients had a tip position that was too shallow, two had ectopic tip positions, and three were located in the correct place). The sensitivity of the method was 95.7% and the specificity was 80%.
As the ECG baselines of patients with persistent atrial fibrillation were difficult to judge and the F wave was irregular, we found that the F wave was significantly higher than before catheter insertion and fell back while withdrawing the catheter, so the catheter should be fed until the F wave significantly increased as the correct position of the catheter tip.
观察持续性心房颤动患者在置入外周中心静脉导管（PICC）过程中心电图（ECG）F 波的变化，并分析 ECG 法（通过 F 波变化）引导 PICC 尖端定位的应用效果。
选择符合纳入标准且需要 PICC 置管的 72 例患者作为研究对象。观察导管尖端到达预定位置时 ECG 的波形。以胸部 X 线结果为金标准，计算 ECG 引导 PICC 尖端定位在心房颤动患者中的灵敏度和特异性，并判断其安全性和准确性。
72 例患者中，ECG 法与胸部 X 线结果比较差异无统计学意义（χ=0.2，p＞0.05）。61 例 ECG 出现 F 波变化，10 例 F 波变化不明显（X 线结果证实 5 例尖端位置过浅，2 例异位尖端，3 例位于正确位置）。该方法的灵敏度为 95.7%，特异性为 80%。
由于持续性心房颤动患者的心电图基线较难判断，F 波不规则，我们发现 F 波在置管前明显升高，在退管时又回落，因此应将导管送入，直至 F 波明显升高，提示导管尖端位于正确位置。
