腔内心电图定位技术预防肿瘤患儿PICC异位的临床意义

Clinical significance of intracavitary electrocardiographic localization in the prevention of PICC heterotopia in children with tumors

目的探讨腔内心电图定位技术在预防婴幼儿肿瘤患儿经外周置入中心静脉导管(PICC)置管过程中导管异位的临床意义。方法选择2016年2月至2020年4月住院符合纳入标准的62例需行PICC置管的患儿为研究对象。置管过程中使用腔内心电图定位技术,以腔内心电图P波波幅增高≥0.5 mV为特征性P波,说明导管尖端到位;P波波幅<0.5 mV为非特征性P波和出现负向波为导管过深,说明导管异位;导管尖端位置位于5~6后肋水平为正常。将心电图定位结果与置管后胸片定位结果比较,计算心电图定位的灵敏度、特异度。结果62例中出现特征性P波56例(90.32%);56例胸片结果显示,导管尖端位置合适33例(位于T5~T6水平,58.93%),导管尖端过深(≥T7水平)22例(39.29%),导管位于非上腔静脉处1例(位于对侧锁骨下静脉1/56,1.79%);未出现特征性P波6例。胸片结果示,导管过深在T8水平1例,过浅在T4水平1例,在非上腔静脉处4例(对侧颈内静脉1例,对侧头臂静脉2例,对侧锁骨下静脉1例)。婴幼儿患儿腔内心电图与胸片一致性对比的敏感度98.21%(55/56),特异度83.33%(5/6)。P波波幅负向波表现,导管位置合适和过深共56例,其中出现负向波24例,导管位置合适的33例中出现负向波2例;导管过深23例中出现负向波22例。结论婴幼儿置管辅助腔内心电图定位与成人、新生儿一样可行和准确,其经济、便捷、避免辐射危害更有利于婴幼儿安全置管,可有效避免导管最终的异位。

Objective To investigate the clinical significance of intracavitary electrocardiogram(EEG)localization in the prevention of catheter ectopic in the process of PICC catheterization in children with tumors.Methods A total of 62 children with tumors who were treated by PICC catheterization in our hospital from February 2016 to April 2020 were enrolled in the study.And the clinical significance of auxiliary intracavitary electroencephalogram(AECEG)localization technique in the prevention of catheter ectopic during PICC catheterization was retrospectively analyzed.During catheterization,intracavitary electrocardiographic localization technique was used.Taking the P wave amplitude≥0.5mV as specific P wave,indicating that the catheter tip was in place.Taking P wave amplitude<0.5mV as non characteristic P wave,and the negative wave as too deep of catheter,indicating catheter ectopic.Finally,the results of ECG localization were compared with those of chest X-ray after catheterization,and the sensitivity and specificity of ECG localization were calculated to explore the clinical significance of ECG localization technology in the prevention of PICC catheterization in children with tumors.Results Amon the 62 patients treated by PICC catheterization,56 cases had characteristic P wave,accounting for 90.32%;The chest X-ray results of the 56 patients showed that the catheter tip position was appropriate in 33 cases(at T5~T6 level),accounting for 58.93%,and 22 cases with too deep catheter tip(≥T7 level)accounted for 39.29%,1 case was located at the non superior vena cava(1 case located in the contralateral subclavian vein),accounting for 1.79%;6 cases had no characteristic P wave.The chest X-ray results showed that the catheter was too deep at T8 level in 1 case,too shallow at T4 level in 1 case,non superior vena cava in 4 cases,contralateral internal jugular vein in 1 case,cephalic brachial vein in 2 cases,and subclavian vein in 1 case.Moreover the sensitivity of consistency contrast between intracavitary electroencephalogram and chest X-ray was 98.21%(55/56)and the specificity was 83.33%(5/6).There were 56 cases with negative P wave amplitude,proper catheter position and excessive depth,including 24 cases with negative wave,negative waves were found in 2 out of 33 patients with appropriate catheter position and 22 out of 23 patients with deep catheter.Conclusion The catheterization assisted intracavitary electroencephalogram localization in children is as feasible and accurate as that in adults and infants,which is economical,convenient,helpful to avoiding radiation hazards,and can effectively avoid the final ectopic catheter.