Download PDF
Am J Perinatol 2024; 41(02): 193-198
DOI: 10.1055/s-0041-1740092
Original Article

Application of Electrocardiogram Localization during Peripherally Inserted Central Catheter Line Insertion into the Persistent Left Superior Vena Cava of Neonates

Liyuan Wu
1   Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Furong, Changsha, Hunan, People's Republic of China
,
Lijia Wan
1   Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Furong, Changsha, Hunan, People's Republic of China
,
Min Peng
1   Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Furong, Changsha, Hunan, People's Republic of China
,
Tian Cao
1   Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Furong, Changsha, Hunan, People's Republic of China
,
Qin Wang
1   Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Furong, Changsha, Hunan, People's Republic of China
,
Xiaori He
1   Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Furong, Changsha, Hunan, People's Republic of China
› Author Affiliations Funding 2019 Clinical Nursing Research Fund Project of the Second Xiangya Hospital of Central South University (2019-HLKY-16).
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Most neonates with persistent left superior vena cava (PLSVC) have no clinical symptoms or hemodynamic changes, and this anomaly is only found during cardiac catheterization, pacemaker implantation, or central venous catheterization. Electrocardiogram (ECG) localization is helpful for the application of the peripherally inserted central catheter (PICC) technique in neonates with PLSVC.

Objective To explore the characteristic waveforms of the P wave when a PICC under ECG localization is applied in neonates with PLSVC.

Study Design The observation and management strategies for the P wave changes during catheter insertion (CI) of two neonates with PLSVC admitted to our institution between January and July 2020, who underwent PICC line insertion, were summarized.

Results The characteristic P wave changes in two children with a PICC line inserted via the PLSVC were observed. When a wide inverted P wave appeared on ECG, the catheter was immediately withdrawn by 0.5 cm, a bidirectional P wave gradually appeared and then disappeared. After that, the catheter was further withdrawn by 0.5 cm. After catheterization, the optimal position of the PICC was confirmed by X-ray photography and bedside B-ultrasound. The PICC line was removed as scheduled after indwelling for 18 and 29 days, respectively, in the two cases, and no PICC-related complications occurred during indwelling.

Conclusion The characteristic P wave changes on ECG during CI provide important clinical reference values for the application of the PICC technique under ECG localization in neonates with PLSVC.

Key Points

  • Electrocardiogram localization.

  • Peripherally inserted central catheter.

  • Persistent left superior vena cava.

Keywords

electrocardiogram localization - persistent left superior vena cava - peripherally inserted central catheter - neonate


Publication History

Received: 16 July 2021

Accepted: 08 October 2021

Article published online:
02 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Pittiruti M, La Greca A, Scoppettuolo G. The electrocardiographic method for positioning the tip of central venous catheters. J Vasc Access 2011; 12 (04) 280-291
    CrossrefPubMedGoogle Scholar
  • 2 Kobayashi M, Ichikawa T, Koizumi J. et al. Aberrant left brachiocephalic vein versus persistent left superior vena cava without bridging vein in adults: evaluation on computed tomography. Ann Vasc Dis 2018; 11 (04) 535-541
    CrossrefPubMedGoogle Scholar
  • 3 Fares WH, Birchard KR, Yankaskas JR. Persistent left superior vena cava identified during central line placement: a case report. Respir Med CME 2011; 4 (03) 141-143
    CrossrefPubMedGoogle Scholar
  • 4 Zhang XX. Cause analysis and countermeasures of P wave inversion in electrocardiogram of PICC catheter into persistent left superior vena cava. J Qilu Nurse 2018; 24 (12) 116-117
    PubMedGoogle Scholar
  • 5 Wu LY, Zhao LP, Wang Q, Peng M, Cao T, Deng YH. Application of ECG localization in PICC line insertion for infants with extremely low birth weight. J Today Nurse 2018; 25 (06) 3-6
    PubMedGoogle Scholar
  • 6 Wu XH. Cause analysis of neonatal PICC complications and research progress in nursing intervention. Chin Nurs Manag 2017; 17 (02) 166-171
    PubMedGoogle Scholar
  • 7 Pei L. Diagnostic value of color Doppler ultrasonography in persistent left superior vena cava. J Imaging Res Med Appl 2019; 3 (23) 186-187
    PubMedGoogle Scholar
  • 8 Wang BH, Wan XL, Huang X. et al. PICC line insertion and nursing care of 6 neonates with persistent left superior vena cava. Chung Hua Hu Li Tsa Chih 2019; 2: 270-273
    PubMedGoogle Scholar
  • 9 Elison B, Evans D, Zanders T, Jeanmonod R. Persistent left superior vena cava draining into the pulmonary venous system discovered after central venous catheter placement. Am J Emerg Med 2014; 32 (08) 943.e1-3
    CrossrefPubMedGoogle Scholar
  • 10 Tyrak KW, Holda J, Holda MK, Koziej M, Piatek K, Klimek-Piotrowska W. Persistent left superior vena cava. Cardiovasc J Afr 2017; 28 (03) e1-e4
    CrossrefPubMedGoogle Scholar
  • 11 Luo HQ, Zhuang H, Zhang HQ, Guo XL, Hou W, Xu YH. Clinical study of P wave changes on PICC head location under ECG monitoring. Nurs. Pract. Res. 2018; 15 (04) 124-126
    PubMedGoogle Scholar
  • 12 Gokhroo RK, Bisht DS, Padmanabhan D, Gupta S. Coronary sinus anatomy: Ajmer Working Group Classification. J Invasive Cardiol 2014; 26 (02) 71-74
    PubMedGoogle Scholar
  • 13 Wu L, Peng M, Cao T. et al. Application of a modified electrocardiogram-guided technique for umbilical venous catheterisation in neonates: a retrospective trial. J Paediatr Child Health 2020; 56 (05) 716-720
    CrossrefPubMedGoogle Scholar
  • 14 Oleti T, Jeeva SM, Thukral A. et al. Does ultrasound guidance for peripherally inserted central catheter (PICC) insertion reduce the incidence of tip malposition? - a randomized trial. J Perinatol 2019; 39 (01) 95-101
    CrossrefPubMedGoogle Scholar