腔内心电图定位经外周静脉置入中心静脉导管尖端的临床应用

Positioning of peripherally inserted central catheters tips using intracavitary electrocardiogram

目的 观察运用腔内心电图特征性P波定位经外周静脉置入中心静脉导管（PICC）尖端的效果。方法 将2015年12月1日至2016年3月31日201例置入PICC的患者，应用心电图机监测腔内心电图特征性P波定位PICC尖端，记录预测深度Y,最高P波深度L、实际置入深度Z，置管成功后患者拍摄全胸正侧位片，由胸片结果确定并记录理想深度H。观察腔内心电图特征性P波定位PICC尖端的敏感性、记录腔内心电图引导定位PICC尖端的操作时间、预测深度与实际置入深度差异。结果 腔内心电图定位PICC尖端敏感性为100%；应用腔内心电图引导PICC尖端定位操作耗时较超声判断PICC异位耗时少［（3.4±2.4）min比（5.6±3.4）min］,差异有统计学意义（P=0.006 9）；腔内心电定位的实际置入深度较预测深度精确［（0.4±0.1）cm比（3.9±0.8）cm］,差异有统计学意义（P=0.007 2）；到达最高P波导管深度L-实际置入深度Z均值（即送管达到P波最高峰后撤导管长度）（4.3±1.6）cm。结论 心电定位法省时、精确率高、简单易学，值得临床普遍应用。

Objective To explore the value of using the characteristic P wave of the intracavitary electrocardiogram （ECG） in positioning the tips of the peripherally inserted central catheters （PICC）. Methods Totally 201 patients with PICC from December 1, 2015 to February 29, 2016 were enrolled in this study. The characteristic P wave of the intracavitary ECG was applied to locate the PICC tips. The pre-determined depth of catheter insertion （Y）, highest P wave （L）, and actual insertion depth （Z） were recorded. Chest radiography was performed after a successful insertion of PICC. The optimal depth （H） was recorded. Then we observed the sensitivity of P wave in positioning PICC tips, the operative time of positioning PICC tip with intracavitary ECG, and the difference in the predicted depth and the actual depth of PICC insertion. Results The sensitivity of the intracavitary ECG in positioning PICC tips was 100%. The operation time of the intracavitary ECG in guiding PICC tip was significantly shorter than the that of ultrasonic diagnosis of ectopic PICC [（3.4±2.4）min vs. （5.6±3.4）min] （P=0.006 9）. The actual depth of ECG-guided positioning was significantly more accurate than the predicted depth [（0.4±0.1）cm vs.（3.9±0.8）cm] （P=0.007 2）. L minused Z averaged （4.3±1.6）cm. Conclusion Positioning PICC tips with ECG is simple, accurate, and easy to learn, and it is worth to be widely used in clinical settings.