• Antonella Capasso, Rossella Mastroianni, Annalisa Passariello, Marta Palma, Francesco Messina, Antonella Ansalone, Italo Bernardo, Daniela Brescia, Francesco Crispino, Carolina Grassia, Attilio Romano, and Gaetano Ausanio.
• 1 Neonatal Intensive Care Unit, Hospital Sant'Anna and San Sebastiano, Caserta, Italy.
• J Vasc Access. 2018 Nov 1; 19 (6): 542-547.

Purpose:The neonatologists of Sant'Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning.Patients And Methods:We enrolled 39 neonates (1-28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head-neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates.Results:No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction-target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected.Conclusion:We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if "peak" P wave is detected.

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