Abstract
Background and purpose
Peripherally inserted central catheter (PICC) used in neurosurgical patients requires changes in patients' head positions. However, such changes can worsen pressure on the brain tissue, lead to sudden acute brain herniation and respiratory arrest, resulting in a higher chance of patient death. This paper addresses the aforementioned problems by introducing a new PICC catheterization method.
Method
In a retrospective study, the records of patients with PICC from April 2020 to April 2023 were reviewed, and they were divided into three groups based on the methods employed. The first group as the conventional group, involved changing patients’ body positions during catheterization. The second group, as the intracavitary electrocardiographic (IECG) group, utilized intracavitary electrocardiographic monitoring and involved changing patients’ body positions during catheterization. The third group as the intracavitary electrocardiographic with improved body positioning (IECG-IBP) group, catheterization was performed with guidance from intracavitary electrocardiographs and without changing the patients’ body positions. The ECG changes among patients undergoing different catheter delivery methods were then compared, as well as the rate of catheter tip misplacement.
Result
The study encompassed a total of 354 cases. Our findings reveal distinct P wave amplitude percentages among the groups: 0% in the conventional group, 88.46% in the IECG group, and 91.78% in the IECG-IBP group. Furthermore, the following catheter tip misplacement rates were recorded: 11.54% for the conventional group, 5.39% for the IECG group, and 5.47% for the IECG-IBP group. Significantly notable differences were observed in these two key indicators between the conventional group and the IECG-IBP group. Notably, the IECG-IBP group demonstrated a more favorable outcome compared to the IECG group.
Conclusion
In patients with neurosurgical diseases, especially those with tracheostomy and nuchal stiffness, the IECG-IBP PICC catheter insertion method can effectively reduce the patient's neck resistance, does not increase the patient's headache and dizziness symptoms, and does not reduce the success of one-time catheterization. Rate and does not increase the incidence of jugular venous ectopia.
Similar content being viewed by others
Introduction
During hospitalization, neurosurgery patients, particularly those with conditions such as sudden hemorrhagic stroke or large brain tumors, are often critically ill. Efficient venous access is crucial in such cases. Repeated venipuncture not only causes pain to patients but also increases the workload of nurses [1,2,3,Full size image
Intracavitary electrocardiographic (IECC) group
First, the patient was connected to the ECG monitor prior to the puncture operation, and it was adjusted to lead II. The basic waveform and heart rate of the patient's ECG were closely observed by the operator. When the catheter was advanced 15 cm into the introducer sheath, the alligator clip electrical connection wire was clamped to the PICC guide wire by the operator. The assistant then clamped the other end of the wire onto the RA lead wire of the monitor electrode wire. The catheter was then delivered by the operator following the conventional method, and the changes in P wave were observed on the electrocardiogram. After successful delivery, the position of the catheter tip was confirmed using chest X-ray checks. The procedure is shown in Fig. 3.
Intracavitary electrocardiographic with improved body positioning (IECG-IBP) group
The catheter was inserted based on the intracavity electrocardiographic positioning technique. Throughout the entire tube delivery process, the patient's head and neck were kept in a central position. When a specific P wave amplitude was observed in the patient's ECG, there was no need to conduct vascular ultrasonography to check the cervical vessels on the side of the patient's catheter. However, in cases where a specific P wave amplitude was not found, such ultrasonography was still necessary. The procedure is shown in Fig. 4.
Evaluations
The indicators used for evaluation are the one-time success rate of catheter delivery and the catheter misplacement rate. Throughout the delivery process, the catheter was considered successfully delivered if it was never retracted. The placement of the catheter tip was assessed based on findings from chest X-rays. The optimal position for the catheter tip is in the lower third of the superior vena cava, near the junction of the superior vena cava and the right atrium [5, 7, 12, 15,16,17]. If the chest radiograph report shows that the catheter was located in the axillary vein, subclavian vein, brachiocephalic vein or internal jugular vein, it is considered misplaced.
Statistical methods
The R software was used for statistical analysis. All analyzes were conducted using two-sided tests, with a confidence level of α = 0.05. Results with P < 0.05 were considered statistically significant. Quantitative data were described as “mean ± standard deviation” if normally distributed, and as median and interquartile range if not. Qualitative data were presented as frequency and percentage. F tests were employed for comparing groups based on the type of data.