Effectiveness of the ECG method in the correct positioning of PICC type central venous catheters in patients with atrial fibrillation.

The peripherally inserted central catheters (PICCs) are third generation silicone or polyurethane catheters, used as venous accesses for long- and medium-term care, and recommended in therapies that require venous access for more than six days. Current implantation methods recommend the radiological method, using standard chest RX in antero-posterior projection, as a method of assessing the correct positioning of the catheter tip. The observational study evaluated the effectiveness in terms of reliability of the intracavitary tip location system (ITLS) method, better known as the ECG method, for the correct positioning of the catheter tip in patients with atrial fibrillation (AFIB); the method exploits the recording of the electrical potential produced by the f waves, expression of the fibrillation of the atrium typical in patients with this disease, the measurement is based on the calculation of the peak-to-peak value of the f waves. They were implanted using this method 101 subjects with previous determination of anthropometric measurement, according to the rule of Peres modified according to Pittiruti, and then subjected to standard thoracic RX in projection antero-posterior and latero-lateral. Our study shows that 97% of the patients implanted with this method at radiological control had the PICC correctly positioned, at an average distance from the hull of 44.9mm; 100% of the patients did not present complications in either the short or medium term. The analysis of the data also shows that the anthropometric evaluations, carried out with the Peres method, corresponded to the correct radiological positioning of the catheter, evaluated with the hull method, only in 45.5% of cases. Our study tends to demonstrate that the ECG-ITLS method, used as a method of intra-procedural control of PICC-type CVC positioning, in patients with atrial fibrillation, has greater reliability than that of anthropometric measurement and equivalent to radiological measurement, but has less chance of incurring in error of reading or projection.

AVATAR®: an electronic evidence-based medicine friendly tool for vascular access planning.

In today's demanding healthcare setting, many patients who are referred to hospital for treatment require some form of intravascular access device to administer required therapies and medications. It is estimated that most of admissions have an intravascular device placed on arrival to any given facility. Often these treatment prerequisites, combined with a wide range of available devices, based upon a combination of patient assessments, necessitated treatment regimens, and the use of a decision algorithm to choose the most appropriate device that provides all the patient's needs, requires a logical and methodical approach during the decision-making process. Several criteria should always remain in high regard for patient and device considerations, such as overall need for a device, the type of drugs or medications being infused, duration of therapy, patient disease states and comorbidities, as well as vessel health, patient age, previous intravascular device history, patient preference, potential site(s) of implantation, and finally, the resources available for ongoing device management. We have developed a tool, called AVATAR, aimed to make easier the implementation of a vascular access planning. It is a newly-designed tool, developed for the clinicians that must decide which type of venous access device is the ideal one in each single patient. It utilizes existing information that may not necessarily be only used by experts, but mainly by any clinician who may be looking for assistance in determining patient requirements. It requires clinical knowledge and it is not designed to be used for determining vascular access choices in emergency situations.