Evaluation of Electrocardiographic Guidance in Accurate Peripherally Inserted Central Catheter Placement in Children.

The placement of peripherally inserted central catheters (PICCs) is an important component of
medical care for a variety of patients. Current practice requires radiographic confirmation
of catheter tip placement prior to use of the line for administration of medications. Often
the final catheter tip position may be uncertain based on radiographic imaging. Other times,
the catheter is malpositioned and requires adjustment and repeat radiographic imaging. In
adult patients, a system of confirmation that is based on electrocardiographic activity has
been implemented and is FDA approved. This study will enroll up to 192 children less than 18
years of age who will receive electrocardiographic guidance for placement of a PICC, in
addition to radiography done as standard care. The investigators will determine the location
of the PICC tip from both ECG and radiograph, and then measure the degree of correlation
between the two methods.

Inclusion Criteria:

- Age from birth to 17 years in need of a PICC as part of the medical treatment plan

- Suitable for an upper extremity PICC placement

- Hemodynamically stable, including patients stable on vasopressors

Exclusion Criteria:

- Hemodynamic instability

- Cardiac abnormality which leads to abnormal p-wave on ECG

- Arrhythmia at baseline, documented duirng the current hospital admission

- Presence of pacemaker or pacing wires which are currently actively pacing

- Patients who have undergone reconstructive cardiac surgery and/or have anatomic
variance that would affect the location of the sinoatrial node in relation to the
superior vena cava

- Premature neonate (<37 weeks estimated gestational age)

- Placement of PICC in lower extremity