Li Ming,Liu Zan,Huang Zhao,et al.Application of intracavity electrocardiography positioning technology in children’s totally implantable venous access ports implantation[J].Journal of Clinical Pediatric Surgery,2024,(07):672-676.[doi:10.3760/cma.j.cn101785-202311045-012]
腔内心电图定位技术在儿童输液港植入术中的应用
- Title:
- Application of intracavity electrocardiography positioning technology in children’s totally implantable venous access ports implantation
- Keywords:
- Intracavitary Electrocardiography; Totally Implantable Venous Access ports; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨腔内心电图在儿童输液港植入术中定位导管尖端位置的准确性和安全性。方法 以湖南省儿童医院普外二科2020年1月至2023年5月收治的需行输液港植入术的66例恶性肿瘤患儿为研究对象,采用传统胸部X线定位的34例为对照组,采用腔内心电图定位的32例为观察组。观察两组患儿定位后导管尖端位于上腔静脉与右心房交界处(cavoatrial junction,CAJ)比例、定位时腔内心电图波形特点、两种定位方法所需时间以及相关并发症发生情况。结果 对照组初次置管有25例导管尖端位于CAJ,初次置管到位率73.5%(25/34);观察组初次置管有30例导管尖端位于CAJ,置管到位率93.7%(30/32);差异有统计学意义(χ2 =4.853,P＜0.05)。观察组32例出现双向或倒置P波,29例出现高振幅的直立特征性P波。对照组C臂定位所需时间为(5.5±1.4)min,观察组定位所需时间为(2.3±0.6)min,差异有统计学意义(P<0.05)。两组患儿置管过程中均无一例并发症发生。结论 在儿童输液港植入术中,与传统的胸部X线定位相比,使用腔内心电图定位导管尖端位置更加快速、准确,而且安全、有效。对于少部分腔内心电图波形改变不典型的患儿,需术中C臂或超声辅助定位。
- Abstract:
- Objective To investigate the accuracy and safety of using intracavitary electrocardiography for positioning the catheter tip during children’s totally implantable venous access ports implantation.Methods Sixty-six children who underwent transfusion port implantation in our department were studied.34 children who underwent traditional chest X-ray positioning were in the control group,while 32 children who underwent intracavitary electrocardiography positioning were in the observation group.The study compared the proportion of catheter tips located at the cavoatrial junction (CAJ) after positioning,the characteristics of intracavitary electrocardiography waveforms during positioning,the time required for each positioning method,and the incidence of related complications between the two groups.Results In the control group,the catheter tip was located at the CAJ in 25 cases,with a first-time placement success rate of 73.5% (25/34).In the observation group,the catheter tip was located at the CAJ in 30 cases,with a first-time placement success rate of 93.7% (30/32),showing a statistically significant difference (χ2 = 4.853,P<0.05).In the observation group,32 cases exhibited biphasic or inverted P waves,and 29 cases exhibited high-amplitude,upright characteristic P waves.The time required for C-arm positioning in the control group was 5.5±1.4 minutes,while the time required for positioning in the observation group was 2.3±0.6 minutes,showing a statistically significant difference (P<0.05).No complications occurred during catheter placement in either group.Conclusions Compared with traditional chest X-ray positioning,using intracavitary electrocardiography for positioning the catheter tip during children’s totally implantable venous access ports implantation is faster,more accurate,safe,and effective.For a small number of children with atypical intracavitary electrocardiography waveform changes,C-arm or ultrasound assistance is needed during surgery for positioning.
参考文献/References:
[1] Gorski LA,Hadaway L,Hagle ME,et al.Infusion therapy standards of practice,8th Edition[J].J Infus Nurs,2021,44(1S):S1-S224.DOI:10.1097/NAN.0000000000000396.
[2] Ignatov A,Hoffman O,Smith B,et al.An 11-year retrospective study of totally implanted central venous access ports:complications and patient satisfaction[J].Eur J Surg Oncol,2009,35(3):241-246.DOI:10.1016/j.ejso.2008.01.020.
[3] Ling QY,Chen H,Tang M,et al.Accuracy and safety study of intracavitary electrocardiographic guidance for peripherally inserted central catheter placement in neonates[J].J Perinat Neonatal Nurs,2019,33(1):89-95.DOI:10.1097/JPN.0000000000000389.
[4] Rossetti F,Pittiruti M,Lamperti M,et al.The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients:results of an Italian multicenter study[J].J Vasc Access,2015,16(2):137-143.DOI:10.5301/jva.5000281.
[5] Pittiruti M,Pelagatti F,Pinelli F.Intracavitary electrocardiography for tip location during central venous catheterization:a narrative review of 70 years of clinical studies[J].J Vasc Access,2021,22(5):778-785.DOI:10.1177/1129729820929835.
[6] Pittiruti M,Hamilton H,Biffi R,et al.ESPEN guidelines on parenteral nutrition:central venous catheters (access,care,diagnosis and therapy of complications)[J].Clin Nutr,2009,28(4):365-377.DOI:10.1016/j.clnu.2009.03.015.
[7] Hellerstein HK,Pritchard WH,Lewis RL.Recording of intracavity potentials through a single lumen,saline filled cardiac catheter[J].Proc Soc Exp Biol Med,1949,71(1):58-60.DOI:10.3181/00379727-71-17078.
[8] 陈霞,蒋秀美,陈晓燕,等.腔内心电图定位技术在完全植入式输液港技术中的应用及效果[J].中国实用护理杂志,2018,34(26):2047-2051.DOI:10.3760/cma.j.issn.1672-7088.2018.26.010. Chen X,Jiang XM,Chen XY,et al.Application and effect of electrocardiograhy on totally implantable venous access ports[J].Chin J Prac Nurs,2018,34(26):2047-2051.DOI:10.3760/cma.j.issn.1672-7088.2018.26.010.
[9] 许菊青,方乐平,沈龙芳,等.超声引导联合腔内心电定位在老年肿瘤病人胸壁输液港植入术中的应用价值[J].实用老年医学,2022,36(11):1133-1136.DOI:10.3969/j.issn.1003-9198.2022.11.013. Xu JQ,Fang LP,Shen LF,et al.Application of ultrasound guidance combined with intracardiac electrocardiogram in the implantment of totally implantable access port in elderly patients with tumor[J].Pract Geriatr,2022,36(11):1133-1136.DOI:10.3969/j.issn.1003-9198.2022.11.013.
[10] 中华护理学会.PICC尖端心腔内电图定位技术:T/CNAS 11-2020[S].北京:中华护理学会,2021. Chinese Nursing Association.The intracardiac electrocardiogram method for positioning the tip of peripherally inserted central catheter:T/CNAS 11-2020[S].Beijing:Chinese Nursing Association,2021.
[11] Liu Z,Zheng X,Zhen YN,et al.Efficacy,safety,and cost-effectiveness of intracavitary electrocardiography-guided catheter tip placement for totally implantable venous access port[J].Ann Vasc Surg,2022,83:168-175.DOI:10.1016/j.avsg.2021.11.021.
[12] Raffaele A,Segal A,Romano P,et al.Intracavitary electrocardiography-guided positioning of central vascular access device can spare unnecessary ionizing radiation exposure in pediatric patients[J].J Vasc Access,2021,22(1):64-68.DOI:10.1177/1129729820923936.
[13] Liu G,Hou WB,Zhou C,et al.Meta-analysis of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement[J].J Vasc Access,2019,20(6):577-582.DOI:10.1177/1129729819826028.
[14] Wang GR,Guo L,Jiang B,et al.Factors influencing intracavitary electrocardiographic P-wave changes during central venous catheter placement[J].PLoS One,2015,10(4):e0124846.DOI:10.1371/journal.pone.0124846.
[15] Pittiruti M,Salerno G,Mancino A,et al.Ultrasound versus intracavitary electrocardiography for intraprocedural tip location during central venous catheterization in infants and children:a prospective clinical study[J].J Vasc Access,2024,25(3):774-778.DOI:10.1177/11297298221132415.
[16] 冯毕龙,姚述远,周素军,等.PICC置管过程中腔内心电图的变化及其对置管操作的指导作用[J].中华护理杂志,2010,45(1):26-28.DOI:10.3761/j.issn.0254-1769.2010.01.009. Feng BL,Yao SY,Zhou SJ,et al.The changes and role of intracavitary electrocardiogram in the placement of peripherally inserted central venous catheters[J].Chin J Nurs,2010,45(1):26-28.DOI:10.3761/j.issn.0254-1769.2010.01.009.
[17] Pelagatti F,Pinelli F.Time to abandon chest X-rays in favor of intracavitary ECG or echocardiography for central venous access tip location:a case of a malpositioned CICC into the internal mammary vein[J].J Vasc Access,2023,24(6):1513-1515.DOI:10.1177/11297298221074751.
[18] 黄一敏,徐伟珏,吴一波,等.小儿完全植入式静脉输液港导管相关性血流感染的诊治--附4例报道[J].临床小儿外科杂志,2020,19(10):939-942,956.DOI:10.3969/j.issn.1671-6353.2020.10.015. Huang YM,Xu WJ,Wu YB,et al.Diagnosis and treatment of catheter-related bloodstream infection of totally implantable venous access ports in children:a report of four cases[J].J Clin Ped Sur,2020,19(10):939-942,956.DOI:10.3969/j.issn.1671-6353.2020.10.015.
备注/Memo
收稿日期:2023-11-28。
基金项目:湖南省临床医疗技术创新引导项目(2021SK50510)
通讯作者:李勇,Email:liyongpuwaike@163.com