CN110694163A - Intracavitary electrocardiogram-based peripherally inserted central catheter positioning algorithm - Google Patents
Intracavitary electrocardiogram-based peripherally inserted central catheter positioning algorithm Download PDFInfo
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- CN110694163A CN110694163A CN201910895275.9A CN201910895275A CN110694163A CN 110694163 A CN110694163 A CN 110694163A CN 201910895275 A CN201910895275 A CN 201910895275A CN 110694163 A CN110694163 A CN 110694163A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
Abstract
The invention relates to a peripherally inserted central catheter positioning algorithm based on intracavitary electrocardio, belonging to the field of medical appliances. The intra-cavity electrocardio-based peripherally inserted central venous catheter positioning algorithm comprises the steps of firstly measuring electrocardiograms of the head end of a PICC catheter at different positions, and calculating the ratio of the P wave amplitude of the electrocardiograms at the different positions to the P wave amplitude of a body surface electrocardiogram to obtain a PAR value; and calculating the amplitude ratio of the P wave and the QRS wave of the electrocardiogram at different positions to obtain the PQAP. Therefore, the relation between the position of the catheter head and the PAR value or the PQAP value is established, and the method for representing the position of the catheter tip by the PAR value or the PQAP value is finally established through data statistics. During the process of placing the catheter, the device can measure the electrocardiogram, display the PAR value or PQAP value and the corresponding expected position of the catheter, prompt the position of the catheter in real time, and prompt the expected position by voice when the catheter reaches the ideal position. Directly convert the electrocardiogram into a PAR value or a PQAP value and a corresponding catheter head position, and medical personnel can directly read the catheter tip position to complete the catheter positioning more quickly and conveniently.
Description
Technical Field
The invention belongs to the field of medical instruments, and particularly relates to a peripherally inserted central venous catheter positioning algorithm based on intracavitary electrocardio.
Background
According to the statistics of the national cancer center, the incidence of cancer in 2017 China accounts for 22% of the world, the standardized incidence rate is 174.0/10 ten thousand, and the world average level is 182.3/10 ten thousand. Chemotherapy is an important means for treating malignant tumors in oncology, and the common clinical administration route is repeated superficial venipuncture administration. The stimulation of the chemotherapy drugs to the blood vessels inevitably causes the damage of the blood vessels.
The use of a peripheral Central venous Catheter (PICC) as a lifeline for patient treatment plays an important role in promoting patient recovery. The PICC catheter provides a safe, long-term vascular access for patients who require chemotherapy, infusion of hypertonic irritant fluids, infusion of strong acid or strong alkaline fluids, and other drugs that disrupt the intima of the blood vessel. The nature of the PICC catheter determines that it is more prone to catheter dislocation than other types of central venous catheters. The optimal position of the head end of the venous catheter is 1/3 sections below the superior vena cava, which is close to the junction of the right atrium (CAJ), the blood flow is large, the medicine can be ensured to be quickly diluted without causing vascular injury, the complication is less, and the safety of a patient is ensured.
The current intravenous catheter tip positioning methods mainly comprise chest X-ray, CT and MR, intracavitary electrocardiogram, ultrasound and the like. Currently, X-ray location of the PICC catheter tip is a commonly used method in China and is also a gold standard recognized worldwide. However, this method has its drawbacks: the position of the tip of the catheter is judged to have hysteresis, so that the ectopic condition of the catheter cannot be found in time, and the patient who has caused the ectopic condition of the catheter often needs to shoot the X-ray film again for positioning after readjusting the catheter. The intracavitary electrocardiography is a method for picking up P waves of an atrium by entering a proximal end through a detection electrode and positioning the tip of a catheter according to the form change of the P waves in the process of placing the venous catheter. The P wave is atrial depolarization wave, the intravenous electrocardiogram is converted into a body surface electrocardiogram through the lead connection, and the electrophysiological change of the P wave of the heart is visualized under the electrocardiographic monitoring. The method has certain requirements on the catheter personnel, needs to see the electrocardiogram and can accurately position the catheter head end through the electrocardiogram P wave, thereby being a technology with higher learning difficulty.
Disclosure of Invention
In order to further improve the tube placing accuracy and efficiency of the venous catheter, reduce the technical threshold of an operator and shorten the learning curve of an operator, the study provides a peripherally inserted central venous catheter positioning algorithm based on intracavitary electrocardio to further improve the one-time arrival rate of the catheter head end positioning and reduce the difficulty of tube placing.
The ECG technology utilizes the characteristic that P waves can generate specific changes at different parts such as superior vena cava, right atrium and the like to achieve the effect of accurately positioning the position of the venous catheter head. Even if the anatomical difference of the superior vena cava exists between different individuals, the head end of the catheter can still accurately reach the accurate position.
When the tip of the catheter does not reach the superior vena cava, the electrocardiogram of the human body is not different, when the tip of the PICC enters the superior vena cava, characteristic positive high-tip P waves appear, when the tip of the catheter enters the right atrium, the P waves reach a peak, after the catheter enters the right atrium, the peak P waves fall back, when the tip of the catheter enters the right atrium, two-phase P waves appear, and the catheter continues to enter and appear inverted negative P waves. Thereby guiding the tip location of the P-catheter by the morphological changes of the P-wave.
When the catheter tip is located in peripheral veins (axillary vein, subclavian vein, brachiocephalic vein), the amplitude of P-wave of the intracavitary electrocardiogram is not significantly different from the body surface electrocardiogram, and recorded as electrocardiogram 1, and the amplitude intensity of P-wave of the electrocardiogram at this time is measured as P1. When the catheter tip just entered the superior vena cava, the amplitude of the P-wave suddenly increased significantly, which was recorded as electrocardiogram 2, with P-wave amplitude intensity P2. As the catheter tip is advanced within the superior vena cava, the recorded intra-luminal electrocardiogram P-wave amplitude is also gradually increased; the maximum amplitude of the P-wave was recorded when the catheter tip was located at the junction of the superior vena cava and the right atrium, which was recorded as electrocardiogram 3 with P3 amplitude intensity. When the tip of the catheter enters the middle and lower part from the top of the right atrium, the amplitude of the P wave begins to gradually decrease or a negative P wave appears, and the electrocardiogram 4 is recorded, and the amplitude intensity of the P wave is P4. The catheter was withdrawn to the maximum amplitude of the P-wave and 0.5-1.5cm, indicating that the tip of the catheter was in the optimal position, at which time an electrocardiogram 5 was recorded, and the amplitude of the P-wave was P5. The above positions were confirmed by X-ray.
Preferably, a P-wave amplitude ratio PAR (ratio of P-wave amplitude intensity at different positions of the catheter tip to P-wave amplitude intensity of the body surface electrocardiogram) is established, and the PAR value is used for corresponding to the position of the catheter tip.
If the PAR value is 4.0, the corresponding relation of the algorithm indicates that the catheter head just enters the superior vena cava.
The implementation of the algorithm is realized by using matched equipment, measuring the electrocardiogram on the equipment, prompting the position of the catheter in real time according to the corresponding relation of the PAR value, and prompting the expected position by voice when the catheter reaches the ideal position.
Preferably, to ensure general applicability and reduced specificity of PAR values, the catheter tip position of the catheterized patient should be collected as much as possible, with at least more than 20 ten thousand patients.
Preferably, the catheter ectopy can be effectively prevented according to the algorithm, and if the PAR value is not changed all the time in the catheterization process, the catheter ectopy is prompted to be positioned at other non-central venous parts.
In addition, the height of the P wave and QRS main wave of the electrocardiogram of the human body can reflect the position of the catheter in the body, and the percentage PQAP (P and QRS amplitude percentage) of the amplitude of the P wave and the amplitude of the QRS wave is proposed to represent the position of the tip of the catheter. Based on the QRS main wave, the method is distinguished by the catheter implantation process:
determination of initial PQAP value from normal electrocardiogram of human body
PQAP value after catheter entry into the superior vena cava
PQAP value at CAJ of catheter
PQAP value when catheter reaches optimal position
PQAP value after catheter entry into right atrium
The position of the catheter is determined by the PQAP value, the length of the catheter from the optimal position is calculated according to the specific length of the catheter and the length of the superior vena cava of the patient, the further pushing depth is determined, and whether the position is correct or not is confirmed again by an electrocardiogram and the PQAP value.
The implementation of the algorithm is realized by using matched equipment, measuring the electrocardiogram on the equipment, prompting the position of the catheter in real time according to the corresponding relation of the PAR value, and prompting the expected position by voice when the catheter reaches the ideal position.
The algorithm is also based on an intracavitary electrocardiogram positioning technology, the electrocardiogram is directly converted into a PAR value or a PQAP value and a corresponding catheter head position, and medical personnel can directly read the catheter tip position, so that the catheter positioning can be completed more quickly and conveniently. Shortening the learning curve of the intracavitary electrocardiogram positioning technology.
Drawings
FIG. 1 is a block diagram of the PAR algorithm for intracavitary electrocardiogram and catheter tip placement
FIG. 2 is a normal electrocardiogram of a human body
FIG. 3 is an electrocardiogram of the catheter reaching the correct position
FIG. 4 is an electrocardiogram of a catheter implanted too deep into the atrium
FIG. 5 is a graphical representation of catheter positioning guided by PAR values
FIG. 6 is a block diagram of the algorithm for establishing PQAP with intracavitary electrocardiogram and catheter tip location
Figure 7 is a diagram of guiding catheter positioning with PQAP values.
Detailed Description
Example 1
FIG. 1 is a block diagram of an algorithm for mapping an intracavitary electrocardiogram to catheter tip location. When the catheter tip is located in the peripheral vein (axillary vein, subclavian vein, brachiocephalic vein), an electrocardiogram was measured, as shown in fig. 2, and the P-wave amplitude intensity of the electrocardiogram was measured to be P1, which was a position where the P-wave amplitude of the electrocardiogram was not significantly different from that of the body surface electrocardiogram and the PAR value was about 1.0. When the catheter is advanced intravenously, but the tip of the catheter has not entered the superior vena cava, the P-wave amplitude is unchanged, and the PAR value is about 1.0. When the catheter tip just enters the superior vena cava, the amplitude of the P wave suddenly increases, the amplitude intensity of the P wave of the electrocardiogram is P2, and the PAR value also increases significantly, as shown in FIG. 3. As the catheter tip is advanced within the superior vena cava, the recorded intra-luminal electrocardiogram P-wave amplitude is also gradually increased; when the catheter tip is located at the junction of the superior vena cava and the right atrium, the P wave with the maximum amplitude is recorded, the amplitude intensity of the P wave of the electrocardiogram is P3, the PAR value also reaches a maximum value interval, when the catheter tip continues to penetrate deeply and reaches the middle part and the lower part of the right atrium, the amplitude of the P wave starts to be gradually reduced or negative P waves appear, the amplitude intensity of the P wave of the electrocardiogram is P4, the electrocardiogram is in a special form, and the PAR value at the moment is recorded so as to prevent similar situations when the catheter is placed, as shown in figure 3. The catheter is withdrawn to the maximum amplitude of the P wave and 0.5-1.5cm, indicating that the catheter tip is at the optimal position, the amplitude intensity of the P wave is P5, and the PAR value indicates that the catheter tip is at the optimal position, as shown in FIG. 4.
From the collection of the big data, and by the algorithm described above, an algorithm was developed that characterized catheter position by PAR values to further guide placement of the transvenous peripheral central venous catheter. As shown in FIG. 5, a puncture vein is first selected and an estimated catheter placement length is measured in vitro. A puncture is then made to place the catheter, at which point the PAR value, as well as the expected catheter location, can be displayed on the auxiliary device. When the PAR value is 1.0, it indicates that the catheter tip has not entered the superior vena cava. When a significant improvement in the PAR occurs, such as greater than 4.0 for PAR, it is an indication that the catheter tip has entered the superior vena cava. At the moment, the catheter is slowly placed, the change of PAR value is observed in real time, and when the numerical interval of the understood position is reached, the placement of the catheter is stopped, which indicates that the placement of the catheter head end is finished. Further confirmation may be made by X-ray filming, if desired.
Example 2
Fig. 6 is a block diagram of an algorithm for mapping an intracavitary electrocardiogram to catheter tip location. When the head end of the catheter is positioned in peripheral veins (axillary veins, subclavian veins and brachiocephalic veins), an electrocardiogram is measured, the amplitude ratio of the P wave and the QRS wave of the electrocardiogram at the moment is measured, and a PQAP value is recorded. When the catheter is advanced intravenously, but the tip of the catheter has not entered the superior vena cava, the P-wave amplitude and PQAP values are unchanged. When the tip of the catheter just enters the superior vena cava, the amplitude of the P wave suddenly increases, and the PQAP value also increases significantly. The recorded PQAP values also gradually increase as the catheter tip advances in the superior vena cava; when the tip of the catheter is located at the junction of the superior vena cava and the right atrium, the maximum amplitude P-wave is recorded, and the PQAP value also reaches a maximum value interval. When the head end of the catheter continues to go deep and reaches the middle part and the lower part of the right atrium, the amplitude of the P wave begins to gradually decrease or negative P waves appear, the electrocardiogram presents a special form, and the PQAP value at the moment is recorded so as to prevent similar situations from appearing when the catheter is placed. The catheter is withdrawn to the maximum amplitude of the P wave and 0.5-1.5cm, indicating that the catheter tip is in the optimal position, and the PQAP value at this time can indicate that the catheter tip is in the optimal position.
Based on the collection of the big data, and by the algorithm described above, an algorithm was built to characterize the catheter position by PQAP values to further guide placement of the transvenous central venous catheter. Referring to fig. 7, a puncture vein is first selected and an estimated catheter placement length is measured in vitro. The puncture catheterization is then performed, at which point the PQAP value, as well as the expected location of the catheter, may be displayed on the ancillary equipment. When the PQAP value is an initial value, it indicates that the tip of the catheter has not entered the superior vena cava. When a significant improvement in the PAR value occurs, such as a PQAP value greater than 30%, it is an indication that the catheter tip has entered the superior vena cava. At the moment, the catheter is slowly placed, the change of the PQAP value is observed in real time, and when the numerical interval of the understood position is reached, the placement of the catheter is stopped, which indicates that the placement of the catheter head end is finished. Further confirmation may be made by X-ray filming, if desired.
Example 3
Identifying the location of the catheter tip based on a parameter may lead to placement bias due to personal variability. The PAR value and PQAP value may be used as two parameters to guide catheter placement. When both the PAR value and the PQAP value enter the ideal interval, it indicates that the catheter tip is placed in the ideal region to further improve accuracy.
The above-described embodiments are merely illustrative of the preferred embodiments of the present invention, and are not intended to limit the scope of the present invention, and various modifications and improvements made to the technical solution of the present invention by those skilled in the art without departing from the spirit of the present invention are intended to fall within the scope of the present invention defined by the claims.
Claims (4)
1. An algorithm for positioning a catheter through a peripheral central vein based on intracavitary electrocardiogram is characterized in that an algorithm of an intracavitary electrocardiogram and a catheter position is established, and the catheter position can be jointly positioned through a PAR value (ratio of P wave amplitude intensity of electrocardiogram at the position of a catheter head to P wave amplitude intensity of electrocardiogram at a body surface electrocardiogram) or a PQAP value (ratio of P wave amplitude of electrocardiogram at the position of the catheter head to QRS wave amplitude) or two ratios.
2. The algorithm of claim 1, wherein the catheter tip location is determined by a PAR value, and a correspondence between the catheter tip location, the intracavitary electrocardiogram, and the PAR value is established. When in use, the position of the head end of the catheter is reversely pushed by the PAR value to guide the catheter to be placed.
3. The algorithm of claim 1, wherein the location of the catheter tip is determined by the PQAP value, and the correspondence between the location of the catheter tip, the location of the intracavitary electrocardiogram, and the PQAP value is determined. When in use, the PQAP value is used for reversely pushing the position of the head end of the catheter to guide the catheter to be placed.
4. The method of claim 1, wherein the algorithm is implemented by using a device adapted to measure electrocardiogram, and real-time indicate the location of the catheter according to the PAR or PQAP value, and when the catheter reaches an ideal location, the algorithm can indicate the expected location by voice.
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Citations (6)
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| CN102802514A (en) * | 2009-06-12 | 2012-11-28 | 巴德阿克塞斯系统股份有限公司 | Catheter tip positioning method |
| CN204016286U (en) * | 2014-07-31 | 2014-12-17 | 南京大学医学院附属鼓楼医院 | A kind of intracavity electrocardiogram guidance system |
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| CN108685605A (en) * | 2017-12-20 | 2018-10-23 | 深圳市科曼医疗设备有限公司 | Catheter tip localization method and system |
| CN110063756A (en) * | 2018-01-24 | 2019-07-30 | 山东百多安医疗器械有限公司 | A kind of artificial intelligence cardiac diagnosis lead Doppler color ultrasound all-in-one machine |
| CN209377563U (en) * | 2018-09-25 | 2019-09-13 | 陈萍 | Femoral vein PICC sets effective intracavitary electrocardiogram guide device |
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2019
- 2019-09-20 CN CN201910895275.9A patent/CN110694163A/en active Pending
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102802514A (en) * | 2009-06-12 | 2012-11-28 | 巴德阿克塞斯系统股份有限公司 | Catheter tip positioning method |
| CN204016286U (en) * | 2014-07-31 | 2014-12-17 | 南京大学医学院附属鼓楼医院 | A kind of intracavity electrocardiogram guidance system |
| CN104771161A (en) * | 2015-04-15 | 2015-07-15 | 深圳开立生物医疗科技股份有限公司 | Catheter tail end positioning method, device and system |
| CN108685605A (en) * | 2017-12-20 | 2018-10-23 | 深圳市科曼医疗设备有限公司 | Catheter tip localization method and system |
| CN110063756A (en) * | 2018-01-24 | 2019-07-30 | 山东百多安医疗器械有限公司 | A kind of artificial intelligence cardiac diagnosis lead Doppler color ultrasound all-in-one machine |
| CN209377563U (en) * | 2018-09-25 | 2019-09-13 | 陈萍 | Femoral vein PICC sets effective intracavitary electrocardiogram guide device |
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Address after: 251100 baiduoan biomedical science and Technology Park, Qilu high tech Development Zone, Qihe County, Dezhou City, Shandong Province Applicant after: Shandong baiduoan Medical Equipment Co.,Ltd. Address before: 251100 baiduoan biomedical science and Technology Park, Qilu high tech Development Zone, Qihe County, Dezhou City, Shandong Province Applicant before: Shandong Branden Medical Device Co.,Ltd. |
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