心房内心电图辅助经外周置入中心静脉导管定位

目的通过10%NaCl注射液导引心房内心电图变化,以辅助经外周置入中心静脉导管(PICC)准确定位。方法10%NaCl作为探测电极,拾取50例接受PICC穿刺的成年患者心房内心电信号,观察心房内心电图P波特征,判断PICC尖端是否位于上腔静脉,并与穿刺后X线胸片检查结果比较,计算敏感度和特异度。结果50例中45例X线胸片证实导管尖端位于上腔静脉(心房内心电图出现P波改变有43例),3例导管尖端位于颈内静脉,2例导管尖端位于腋静脉。以X线胸片结果为金标准,通过10%NaCl注射液导引心房内心电图辅助PICC定位的灵敏度为96%,特异度100%。结论以10%NaCl注射液引导心房内心电图,辅助判断PICC的定位可作为X线胸片检查的替代方法应用于临床。

Study of Endocavitary Electrocardiography of Atrium Cordis Guided Cannulation in the Placement of PICC

Objective To evaluate the accuracy of placing a Peripheral Inserted Central Catheter(PICC) by observing the characteristic of P-wave changes in endocavitary electrocardiography(ECG) with the conducti-bility of 10% NaCl injection. Methods Clinical data of 50 adult patients who required a PICC were studied and their endocavitary ECG of atrium cordis were obtained by using 10% NaCl injection as exploratory electrode. The tip of PICC through vena cava was observed whether or not by the characteristic of P-wave changes, and the re-sults were compared with results of chest X-ray. The sensitivity and specificity were calculated. Results 45 of the patients were confirmed the tip of PICC through vena cava by chest X-ray (including 43 patients with the char-acteristic of P-wave changes), and 3 within the internal jugulr veins 2 within the internal axillary vein. Taken the results of chest x-ray as a gold standard, the sensitivity and specificity of endocavitary ECG of atrium cordis, which guided cannulation in placement of PICC, were 96%, and 100% by the conductibility of 10% NaCl injec-tion. Conclusion The technique of endocavitary ECG of atrium cordis, which guides cannulation in the plac-ement of PICC by the conductibility 10% NaCl injection, is a safe alternative for the chest radiograph to detect ac-curate placement of PICC.