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Figure 3: Downward deflection on the leading edge of the P wave -
catheter tip is entering the right atrium.
Figure 4: Biphasic P wave – catheter tip is within the right atrium.
Figure 5: Inverted P wave - catheter tip is approaching the right
ventricle.
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Confirm all Bundle Protocol Parameters have been met.
Catheter Insertion
Catheter advanced to target without
resistance?
Stylet removed from catheter without
resistance?
Catheter Functionality
Positive/free flowing blood return (all lu-
mens)?
Flushing without resistance (all lumens)?
Objective Assessment
US assessment of internal jugular vein
negative for catheter?
EKG tip location agrees with surface mea-
surement (+/- 2cm)?
ECG P Wave Assessment
Initial P wave downward deflection noted
and documented?
P wave amplification noted & highest
waveform documented?
Warning: If "no" is selected for "were all parameters met", you
cannot rely solely on the ECG interpretation by C3 Wave™ system.
You must obtain additional confirmation with chest x-ray or
fluoroscopy to confirm the PICC tip location.
Warning: Failure to verify catheter placement may result in serious
trauma or fatal complications.
A.
As the catheter is advanced toward the SVC/Right atrial
junction the P-wave height will increase.
B.
Advance Catheter until downward deflection is seen on the
leading edge of the P-wave. Select the "snapshot icon" using the
Remote Control to save the ECG waveforms.
Note: P-wave may continue to increase in amplitude when initial
downward deflection is observed. In this case, adjust catheter tip
position to maximum P-wave amplitude with no downward
deflection as shown below.
C.
Pull catheter back until maximum P-wave is achieved.
D.
Select the "snapshot" icon using the Remote Control Cable
to save the ECG waveforms. Refer to the C3 Wave™ Owners
Manual.
E.
Using the C3 Wave™ system, central venous catheter tip
location can be documented for the patient's chart. Refer to C3
Wave™ Owner's Manual.
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