The purpose of this study is to investigate the accuracy and safety of intracavitary electrocardiogram (IC-ECG) guidance for the localization of peripherally inserted central catheter (PICC) in neonatal patients. A total of 160 neonatal patients were randomly assigned to receive either anthropometric measurement combined with IC-ECG guidance (n = 80) or conventional anatomical landmark guidance (n = 80) for PICC catheter tip positioning. The catheter tip position was confirmed by postinsertion radiograph and data were interpreted by independent radiologists. Subsequent catheter-related complications of neonates between 2 groups were also compared. The first-attempt target rate was 95.0% (95% confidence interval, 90.1%-99.9%) in IC-ECG–guided PICCs, significantly higher than 78.8% (95% confidence interval, 69.6%-87.9%) in the anatomical landmark guidance group (P < .05). In contrast, IC-ECG–guided PICCs provided a significantly lower overall incidence of the catheter-related complications (3.75%), compared with those guided by anatomical landmarks only (23.75%). Thus, combined use of anatomical landmark and IC-ECG guidance improved the first-attempt target rate of PICC placement and decreased catheter-related complications. These findings indicated a superior accuracy and safety of IC-ECG guidance to conventional anatomical landmark method in neonatal PICC practice.
Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital and Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China (Mr Binzhi Tang and Mss Ling, Chen, and Min Tang, and Mr Binzhi Tang), Chengdu, Sichuan Province, China); and Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan Province, China (Ms Qu).
Corresponding Author: Binzhi Tang, MD, PhD, Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, No. 32 West Second Section First Ring Rd, Chengdu, Sichuan Province, China 610072 (email@example.com).
This work was supported by grants from Doctoral Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (no. 30305030580), Open Fund of the National Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education (no. 2016001), and grants from Science and Technology Bureau of Sichuan province (no. 2016TD0002) and Research Project of Sichuan Provincial Health and Family Planning Commission (no. 17PJ315).
Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Each author has indicated that he or she has met the journal's requirements for Authorship.
Submitted for publication: January 14, 2018; accepted for publication: November 11, 2018.