An accuracy study of the Intracavitary Electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates

Objective: To explore the clinical application of the intracavitary electrocardiogram (IC-ECG) guided Peripherally Inserted Central Catheter (PICC) tip placement among neonates. Background: the ECGs of neonates are difficult to perform and their wave shapes are of doubtful accuracy due to various interfering factors Method: 115 neonates were admitted to perform PICC guided by IC-ECG. Logistic regression was performed to analyze all possible influencing factors of the accuracy from the tip placement. The puncture site of the PICC, gestational age, height, weight, basal P/R amplitude and positioning P/R amplitude might be related to the accuracy of IC-ECG location. Result: The accuracy in the lower extremity was higher than that in the upper extremity. Multivariate logistic regression analysis showed that the weight (Odds Ratio (OR)=1.93, 95% Confidence Interval(CI): 1.06-3.50) and positioning P/R amplitude (OR = 32.33, 95% CI: 2.02-517.41) are statistically significant risks to the accuracy PICC tip placement. Conclusions Possible methods to improve the accuracy might be Catheterizing through lower extremity, keeping the neonates calm, enhancing the electrocardiogram signal and strengthening technical training. Therefore it is practical to perfrom a tip placement by the dynamic change in the P waves from an electrocardiogram (ECG) guided PICC among neonates and as reliable as using X-rays.