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Intracavitary electrocardiography-guided positioning of central vascular access device can spare unnecessary ionizing radiation exposure in pediatric patients.

腔内心电图引导定位中心血管通路装置可以避免儿科患者不必要的电离辐射暴露。

  • 影响因子:1.12
  • DOI:10.1177/1129729820923936
  • 作者列表:"Raffaele A","Segal A","Romano P","Vatta F","Boghen S","Bonetti F","Parigi GB","Avolio L
  • 发表时间:2021-01-01
Abstract

BACKGROUND:Most hospital protocols-including those of our own institute-require the use of radiography to validate tip position in every central vascular access device placement. This study evaluated whether unnecessary ionizing radiation exposure could be spared in the pediatric population when intracavitary electrocardiography is used to guide catheter placement. MATERIAL AND METHODS:Retrospective study of intracavitary electrocardiography-guided central vascular access device placements in our pediatric surgery department between 2013 and 2018. We evaluated the operating time, success in positioning the catheter, and accuracy of final tip position. We also assayed the effects of catheter type and of catheter access point on operating time, success, accuracy, and complications. We applied the chi-square test for statistical analysis. RESULTS:In total, 622 interventions of central vascular access device placements were evaluated; 340 intracavitary electrocardiography-guided central vascular access device placements were included in the study. The electrocardiography method successfully positioned the tip of the catheter in 316/340 (92.94%) of placements. Where intracavitary electrocardiography placement was successful, radiography confirmed accuracy of tip position in 314/316 (99.41%) of placements. CONCLUSION:When electrocardiography-guided positioning is uneventful and a valid P-Wave pattern is seen, postprocedure radiograph imaging for verification is unnecessary. Any effort should be made to upgrade hospital policies according to evidences and newest guidelines to spare pediatric patients harmful exposure to radiation by limiting the use of radiography only to selected cases.

摘要

背景: 大多数医院协议 -- 包括我们自己研究所的协议 -- 要求在每个中央血管通路装置放置中使用放射摄影术来验证尖端位置。本研究评估了当腔内心电图用于指导导管放置时,儿童人群是否可以避免不必要的电离辐射暴露。 材料和方法: 回顾性研究2013年至2018年间在我们的小儿外科腔内心电图引导下中心血管通路装置的安置。我们评估了操作时间、导管定位的成功率和最终尖端位置的准确性。我们还分析了导管类型和导管接入点对操作时间、成功率、准确性和并发症的影响。我们应用卡方检验进行统计分析。 结果: 共评估了622例中心血管通路装置置入的干预措施; 340例腔内心电图引导的中心血管通路装置置入纳入研究。心电图方法成功地将导管的尖端定位在316/340 (92.94%) 的放置中。如果腔内心电图放置成功,则在314/316 (99.41%) 的放置中,x线片证实了尖端位置的准确性。 结论: 当心电图引导定位顺利,看到有效的P波模式时,不需要进行术后x线成像验证。应根据证据和最新指南努力升级医院政策,通过限制仅在选定病例中使用放射线照相术来避免儿科患者有害暴露于辐射。

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