The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study

Abstract

Purpose:

The neonatologists of Sant’Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning.

Patients and methods:

We enrolled 39 neonates (1–28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head–neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates.

Results:

No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction–target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected.

Conclusion:

We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if “peak” P wave is detected.

Keywords

Epicutaneous cava catheter intracavitary electrocardiography neonates peripherally inserted central catheter target zone tip position

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References

Cartwright

DW.

Central venous lines in neonates: a study of 2186 catheters. Arch Dis Child Fetal Neonatal Ed 2004; 89(6): F504–F508.

Westergaard

Classen

Walther-Larsen

Peripherally inserted central catheters in infants and children—indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand 2013; 57(3): 278–287.

Ares

Hunter

CJ.

Central venous access in children: indications, devices, and risks. Curr Opin Pediatr 2017; 29(3): 340–346.

Beardsall

White

Pinto

et al . Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem? Arch Dis Child Fetal Neonatal Ed 2003; 88(4): F292–F295.

Darling

Newell

Mohamdee

et al . Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol 2001; 21(7): 461–464.

Askegard-Giesmann

Caniano

Kenney

BD.

Rare but serious complications of central line insertion. Semin Pediatr Surg 2009; 18(2): 73–83.

Jain

Deshpande

Shah

Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 2013; 33(4): 307–312.

Colacchio

Deng

Northrup

et al . Complications associated with central and non-central venous catheters in a neonatal intensive care unit. J Perinatol 2012; 32(12): 941–946.

Yoon

Shin

et al . Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients. Br J Anaesth 2005; 95(4): 514–517.

10.

Albrecht

Breitmeier

Panning

et al . The carina as a landmark for central venous catheter placement in small children. Eur J Pediatr 2006; 165(4): 264–266.

11.

Ahn

Chung

JH.

Proper tip position of central venous catheter in pediatric patients. J Vasc Access 2015; 16(5): 399–402.

12.

Inagawa

Tanaka

et al . The carina is not a landmark for central venous catheter placement in neonates. Paediatr Anaesth 2007; 17(10): 968–971.

13.

Pittiruti

La Greca

Scoppettuolo

The electrocardiographic method for positioning the tip of central venous catheters. J Vasc Access 2011; 12(4): 280–291.

14.

Baldinelli

Capozzoli

Pedrazzoli

et al . Evaluation of the correct position of peripherally inserted central catheters: anatomical landmark vs. electrocardiographic technique. J Vasc Access 2015; 16(5): 394–398.

15.

Pittiruti

Bertollo

Briglia

et al . The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. J Vasc Access 2012; 13(3): 357–365.

16.

Rossetti

Pittiruti

Lamperti

et al . The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study. J Vasc Access 2015; 16(2): 137–143.

17.

Zhou

Liang

et al . Effectiveness of intracavitary electrocardiogram guidance in peripherally inserted central catheter tip placement in neonates. J Perinat Neonatal Nurs 2017; 31: 326–331.

18.

Zhou

Xua

et al . An accuracy study of the intracavitary electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates. Open Med 2017; 12: 125–130.