Development And Evaluation Of The Intracavitary Electrocardiogram Guided PICC Placement Procedure

ObjectivesTo establish a clinical applicable procedure of intracavity electrocardiogram(IC-ECG)guiding peripherally central venous catheter(PICC)placement,and to provide a reference for the safe implementation and management of IC-ECG technique.MethodsThe content analysis method was used for critical links of IC-ECG guided PICC placement.After searching the IC-ECG related scientific researches,screening articles for PICC placement,coding and extracting the text,analyzing the results,the critical links were finally concluded.In consideration of clinical practice and critical links that were determined above,the draft of the IC-ECG guided PICC placement procedure was consulted and revised according to a two-round Delphi method.The final version of the procedure was used in a PICC training class and evaluated by students’ feedback of clinical application reports and scoring of the procedure.Results1.A total of 44 articles were screened,coded and analyzed after literature searching.There were 7 critical links and 12 items about the IC-ECG technique in PICC placement determined,including indications and contraindications,prepare work of materials,patients and the surroundings,PICC tip placement along with IC-ECG guidance,electrocardiogram(ECG)recording and radiographic confirmation of the tip position.2.Experts’ opinions tended to be consistent after two rounds of consultation.There were 35 and 33 experts participated in the first and second round of consultant.The questionnaire recovery rate was 76.1%and 94.3%,and the expert authority coefficients were 0.954 and 0.958,respectively.In the first round of Delphi consultation,the expert opinions coordination coefficients of the primary and secondary-level items were 0.148 and 0.168,and the proportion of experts who put forward opinions was 57.1%;in the second round of consultation,the expert opinions coordination coefficients of the primary and secondary-level items were 0.245 and 0.210,the proportion of experts who provided opinions was 63.6%.The final procedure of IC-ECG guided PICC placement includes 12 primary-level and 32 secondary-level items.3.Overall,196 PICCs were placed by 68 students.The accuracy of IC-ECG guided PICC placement was 97.45%,and the overall clinical applicability of the procedure was scored(8.57 ± 0.60).Conclusions1.This study found that the operating procedure of IC-ECG guided PICC placement in different studies differed widely in terms of scope of application,preparation of materials,location of PICC tip in IC-ECG,and ECG recordings.To standardize the implementation and management of the IC-ECG technique in PICC placement,there is an urgent need in establishing a need to explore a comprehensive,scientific and clinically applicable procedure for IC-ECG guided PICC placement.2.The IC-ECG guided PICC placement procedure was well-established through the Delphi method and the content analysis method.3.After training,applying and feedbacking of the procedure in a preliminary test,the results proved to be well-organized with quality and clinical applicability.