Application of f-wave to QRS complex amplitude ratio in PICC tip positioning for patients with atrial fibrillation
10.3761/j.issn.0254-1769.2025.13.003
- VernacularTitle:f波与QRS波振幅比值在房颤患者PICC尖端定位中的应用研究
- Author:
Lihua SHI
1
;
Rongrong YANG
;
Lihong LIAO
;
Jing GUO
;
Qiu SUN
;
Yuanyuan GONG
;
Jiabao YE
;
Jianfang ZHANG
Author Information
1. 215008 苏州市 南京医科大学附属苏州医院护理部
- Publication Type:Journal Article
- Keywords:
Atrial Fibrillation;
Intracardiac Electrogram;
Peripherally Inserted Central Catheter;
Tip Positioning;
Nursing Care
- From:
Chinese Journal of Nursing
2025;60(13):1553-1557
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the clinical utility of the f-wave to QRS complex amplitude ratio(f/R ratio)in intracardiac electrogram(IC-ECG)-guided positioning of peripherally inserted central catheter(PICC)tips in patients with atrial fibrillation(AF),providing evidence to enhance clinical practice.Methods This study employed a conve-nience sampling method to enroll eligible AF patients admitted to a tertiary hospital in Suzhou from July 2023 to July 2024.During PICC placement,IC-ECG was utilized to monitor f-wave and QRS complex amplitude variations.Following successful catheterization,the f/R ratio was measured,and chest X-ray was performed to confirm the catheter tip position.The accuracy of PICC tip positioning across different f/R ratio ranges was analyzed,and the incidence of arrhythmias was recorded.A receiver operating characteristic curve was constructed to assess the diag-nostic performance of the f/R ratio in PICC tip localization.Results A total of 68 AF patients were included,with f/R ratios ranging from 20.63％to 91.24％.PICC tip positioning accuracy varied significantly across different f/R ratio ranges(P=0.006).The area under the ROC curve(AUC)for f/R ratio in PICC tip positioning was 0.784(P=0.009),with a maximum Youden index of 0.567,an optimal diagnostic threshold of 40.00％,a sensitivity of 81.7％,a speci-ficity of 75.0％,a positive predictive value of 96.1％,and a negative predictive value of 35.3％.No arrhythmias other than AF occurred during the procedure.Conclusion The f/R ratio provides reliable and safe guidance for PICC tip positioning in AF patients.An f/R ratio ≥40％is associated with higher accuracy in identifying the optimal catheter tip position.
