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经下肢皮下单腔心内电图引导在新生儿中放置心内导管尖端的位置:一项回顾性研究。

The positioning of the catheter tip with an intracavitary electrocardiogram in epicutaneo-caval catheter placement via lower limbs in newborns: A retrospective study.

机构信息

Department of Paediatrics, Shijiazhuang People's Hospital, Shijiazhuang, China.

Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang, China.

出版信息

J Vasc Access. 2024 Jan;25(1):119-124. doi: 10.1177/11297298221100174. Epub 2022 May 30.

Abstract

OBJECTIVE

Few studies have been conducted on whether catheterisation via the lower limb pathway is suitable for intracavitary electrocardiogram (ECG) technology. This study explored the positioning of the epicutaneo-caval catheter (ECC) tip with intracavitary ECG via the lower limbs in newborns to determine its optimal placement and to improve the success rate of ECC placement using this method.

METHODS

Twenty-eight cases were selected for the observation group. The tip location with intracavitary ECG method was used to observe the changes in specific atrial depolarisation (P-wave) during the catheterisation process to determine whether the catheter tip was in the correct position. For comparative observation, chest X-rays and abdominal radiographs were taken within 24 h to determine sensitivity and specificity. The control group included 28 cases where the ECCs were inserted via the lower limbs, and chest X-rays and abdominal radiographs were taken within 24 h after the line was placed to confirm the correct positioning.

RESULTS

The success rate of the observation group was 91.30% (there were two cases of primary malposition), and the success rate of the control group was 78.57% (there were six cases of primary malposition). The success rate of the observation group was higher compared with the control group.

CONCLUSION

The tip location with intracavitary ECG method improved the success rate of ECC placement via the lower limbs in neonates. This method can effectively prevent the occurrence of lower limb primary catheter malposition and has significant clinical application value.

摘要

目的

鲜有研究探讨经下肢入路行心腔内心电图(ECG)技术时行导管插入术是否合适。本研究旨在通过下肢心腔内 ECG 探讨新生儿经皮股静脉导管(ECC)尖端的定位,以确定其最佳位置,并提高该方法放置 ECC 的成功率。

方法

选择 28 例作为观察组,采用心腔内 ECG 方法观察导管插入过程中特定心房去极化(P 波)的变化,以确定导管尖端是否位于正确位置。为了进行对比观察,对 28 例患者在置管后 24 小时内行胸部 X 线和腹部平片检查,以确定敏感性和特异性。对照组为 28 例行下肢 ECC 插入的患者,在置管后 24 小时内行胸部 X 线和腹部平片检查以确认正确定位。

结果

观察组的成功率为 91.30%(有 2 例为原发性错位),对照组的成功率为 78.57%(有 6 例为原发性错位)。观察组的成功率高于对照组。

结论

心腔内 ECG 尖端定位法提高了新生儿经下肢 ECC 置管的成功率。该方法可有效预防下肢原发性导管错位的发生,具有显著的临床应用价值。

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