Comparison of Two ECG Guided PICC Insertion Techniques

"ECG electrodes are placed on patient's chest ensuring that there is a distinguishable P-wave.~Upper arm selection is based on vein diameter and dominance, ultrasound is used to identify a suitable vein.~The patient is prepared using a maximal sterile barrier approach. The catheter is inserted into one of the veins (75-90° arm abduction) using ultrasound and modified Seldinger technique.~The PICC is advanced into the central circulation and used as an intracavitary electrode (connection with Vygocard2™). Saline water instilled through the catheter ensures conductivity.~The ECG is then used until displayed intracavitary P-wave has a maximal height without negative deflexion. Catheter is left at this point (cavo atrial junction).~The PICC hub side is then trimmed and the catheter part connected. The PICC is caped with a neutral bidirectional valve.~The puncture site is dressed and catheter stabilized. Chest Xray is obtained immediately after insertion to assess the position."

"ECG electrodes are placed on patients chest ensuring that there is a distinguishable P-wave.~Upper arm selection is based on vein diameter and dominance, ultrasound is used to identify suitable vein.~The patient is prepared using a maximal sterile barrier approach. The catheter is inserted into one of the veins (75-90° arm abduction) using ultrasound and modified Seldinger technique.~The catheter's free end is cut to the anticipated length using anthropometric measurements (insertion/axillary crease+axillary crease/sternal notch+13cm) and the preloaded magnetic-tipped stylet (serving as intracavitary electrode) is put inside.~The PICC is advanced into central veins until intravascular ECG displays a P-wave with maximal height without negative deflexion. Catheter is left at this point (cavo atrial junction).~The puncture site is dressed and catheter stabilized. Chest Xray is obtained immediately after insertion to assess position."