Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients

Ying Wu; Guohua Huang; Jinai He; Qiufeng Li; Yutong Li

doi:doi:10.11648/j.ajns.20211001.29

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Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients

Ying Wu, Guohua Huang, Jinai He, Qiufeng Li, Yutong Li

Published in American Journal of Nursing Science (Volume 10, Issue 1)

Received: 20 January 2021 Accepted: 15 February 2021 Published: 26 February 2021

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Abstract

Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.

Published in	American Journal of Nursing Science (Volume 10, Issue 1)
DOI	10.11648/j.ajns.20211001.29
Page(s)	98-101
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Peripherally Inserted Central Catheter (PICC), Intracardiacelectrogram (IEGM), P Wave Morphology, Double-peaked P Wave, Peaked P Wave

References

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[2]	Dale M, Higgins A, Carolan-Rees G. Sherlock 3CG (R) tip confirma-tion system for placement of peripherally inserted central catheters: a NICE medical technology Guidance. Appl Health Econ Health Policy. 2016; 14 (1): 41-49.
[3]	Hostetter R, Nakasawa N, Tompkins K, Hill B. Precision in central venous catheter tip placement: a review of the literature. J Assoc Vasc Access. 2010; 15 (3): 112-125.
[4]	Oliver G, Jones M. ECG or X-ray as the “gold standard” for establishing PICC-tip location? Br J Nurs. 2014; 23 (Suppl 19): S10–S16.
[5]	Infusion Nurses Society. Infusion nursing standards of practice. Supple- ment to January / February 2011, 34: S40.
[6]	Pittiruti M, Bertollo D, Briglia E, et al. The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study [J]. J Vasc Access, 2012, 13 (3): 357-65.
[7]	Oliver G, Jones M. ECG-based PICC tip verification system: an evaluation 5 years on. Br J Nurs. 2016; 25 (19): S4–S10.
[8]	Nancy LM, Glenda LD, Elizabeth A, et al. Electrocardiogram guided peripherally inserted central catheter placement and tip position: Results of a trial to replace radiologiea [confirmation EJ]. JAVA, 2010, 15 (1): 8-14.
[9]	Schummer W, Herrmann S, Schummer C, et al. Intra-atrial ECG is not a reliable method for positioning left internal jugu¬lar vein catheter [J], Br J Anaesth, 2003, 91 (4): 481-486.
[10]	Zhou L, Xu H, Liang J, Xu M, Yu J. Effectiveness of intracavitary electrocardiogram guidance in peripherally inserted central catheter tip placement in neonates. J Perinat Neonatal Nurs. 2017; 31 (4): 326–331.
[11]	Rossetti F, Pittiruti M, Lamperti M, Graziano U, Celentano D, Capozzoli G. 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.
[12]	Pittiruti M, Scoppettuolo G, La Greca A, et al. The EKG method for positioning the tip of PICCs: results from two preliminary studies. J Assoc Vasc Access. 2008; 13 (4): 179–186.
[13]	Pittiruti M, La Greca A, Scoppettuolo G. The electrocardiographic method for positioning the tip of central venous catheters. J Vasc Access. 2011; 12 (4): 280-291.
[14]	Li L, Chen YX, Li XJ, Clinical significance of P wave morphology and changes for intracardiacelectrogram-guided PICC [J]. Journal of Nurses Training, 2017 (6), 557-558. DOI: 10.16821/j.cnki.hsjx.2017.06.026

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APA Style

Ying Wu, Guohua Huang, Jinai He, Qiufeng Li, Yutong Li. (2021). Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients. American Journal of Nursing Science, 10(1), 98-101. https://doi.org/10.11648/j.ajns.20211001.29

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ACS Style

Ying Wu; Guohua Huang; Jinai He; Qiufeng Li; Yutong Li. Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients. Am. J. Nurs. Sci. 2021, 10(1), 98-101. doi: 10.11648/j.ajns.20211001.29

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AMA Style

Ying Wu, Guohua Huang, Jinai He, Qiufeng Li, Yutong Li. Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients. Am J Nurs Sci. 2021;10(1):98-101. doi: 10.11648/j.ajns.20211001.29

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@article{10.11648/j.ajns.20211001.29,
  author = {Ying Wu and Guohua Huang and Jinai He and Qiufeng Li and Yutong Li},
  title = {Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients},
  journal = {American Journal of Nursing Science},
  volume = {10},
  number = {1},
  pages = {98-101},
  doi = {10.11648/j.ajns.20211001.29},
  url = {https://doi.org/10.11648/j.ajns.20211001.29},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20211001.29},
  abstract = {Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.},
 year = {2021}
}

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TY  - JOUR
T1  - Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients
AU  - Ying Wu
AU  - Guohua Huang
AU  - Jinai He
AU  - Qiufeng Li
AU  - Yutong Li
Y1  - 2021/02/26
PY  - 2021
N1  - https://doi.org/10.11648/j.ajns.20211001.29
DO  - 10.11648/j.ajns.20211001.29
T2  - American Journal of Nursing Science
JF  - American Journal of Nursing Science
JO  - American Journal of Nursing Science
SP  - 98
EP  - 101
PB  - Science Publishing Group
SN  - 2328-5753
UR  - https://doi.org/10.11648/j.ajns.20211001.29
AB  - Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.
VL  - 10
IS  - 1
ER  -

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Author Information

Ying Wu

Department of Venous Catheterization, The First Affiliated Hospital of Jinan University, Guangzhou, China
Guohua Huang

Department of Venous Catheterization, The First Affiliated Hospital of Jinan University, Guangzhou, China
Jinai He

Department of Venous Catheterization, The First Affiliated Hospital of Jinan University, Guangzhou, China
Qiufeng Li

Department of Venous Catheterization, The First Affiliated Hospital of Jinan University, Guangzhou, China
Yutong Li

Department of Venous Catheterization, The First Affiliated Hospital of Jinan University, Guangzhou, China

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Plain Text BibTeX RIS

APA Style

Ying Wu, Guohua Huang, Jinai He, Qiufeng Li, Yutong Li. (2021). Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients. American Journal of Nursing Science, 10(1), 98-101. https://doi.org/10.11648/j.ajns.20211001.29

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ACS Style

Ying Wu; Guohua Huang; Jinai He; Qiufeng Li; Yutong Li. Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients. Am. J. Nurs. Sci. 2021, 10(1), 98-101. doi: 10.11648/j.ajns.20211001.29

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AMA Style

Ying Wu, Guohua Huang, Jinai He, Qiufeng Li, Yutong Li. Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients. Am J Nurs Sci. 2021;10(1):98-101. doi: 10.11648/j.ajns.20211001.29

Copy | Download

@article{10.11648/j.ajns.20211001.29,
  author = {Ying Wu and Guohua Huang and Jinai He and Qiufeng Li and Yutong Li},
  title = {Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients},
  journal = {American Journal of Nursing Science},
  volume = {10},
  number = {1},
  pages = {98-101},
  doi = {10.11648/j.ajns.20211001.29},
  url = {https://doi.org/10.11648/j.ajns.20211001.29},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20211001.29},
  abstract = {Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients
AU  - Ying Wu
AU  - Guohua Huang
AU  - Jinai He
AU  - Qiufeng Li
AU  - Yutong Li
Y1  - 2021/02/26
PY  - 2021
N1  - https://doi.org/10.11648/j.ajns.20211001.29
DO  - 10.11648/j.ajns.20211001.29
T2  - American Journal of Nursing Science
JF  - American Journal of Nursing Science
JO  - American Journal of Nursing Science
SP  - 98
EP  - 101
PB  - Science Publishing Group
SN  - 2328-5753
UR  - https://doi.org/10.11648/j.ajns.20211001.29
AB  - Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.
VL  - 10
IS  - 1
ER  -

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