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  • Title: ECG method for positioning the tip of peripherally inserted central catheters in patients with atrial fibrillation.
    Author: Zhao C, Zhu Y, Yin X, Zhang C, He Y, Gao J.
    Journal: Ann Noninvasive Electrocardiol; 2022 May; 27(3):e12931. PubMed ID: 35174568.
    Abstract:
    OBJECTIVE: 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. METHODS: 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. RESULTS: Of the 72 patients, there was no significant difference between the ECG method and chest X-ray results (χ2 = 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%. CONCLUSION: 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.
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