Abstract: Objective: To explore clinical application protocol and preliminary effect of magnetic navigation combined with Intracardiac Electrocardiogram (IC-ECG) tip confirming technique for PICC insertion in China, provide reference for the development of this technique. Methods: According to previous studies and relevant domestic standards, formulated the clinical application protocol of this technique. Applied this technique to insert PICCs for 10 patients with cancer according to the protocol. Observed the PICC insertion process; analyzed the PICC tip magnetic navigation, IC-ECG and X-ray; recorded actual time spent on X-ray and medical costs; observed symptoms/signs of catheter-related venous thrombosis, infection (intravenous site infection and Central Line-Associated Bloodstream Infection) during the 28-day observation period; investigated operator feedback. Results: Successfully inserted PICCs on first-attempt for 10 patients. Real-time magnetic navigation facilitated continuous tip tracking during insertion, enabling immediate correction of 2 primary tip malposition cases. Characteristic P-wave amplitude maximization was observed in all IC-ECG recordings, with subsequent radiographic confirmation of tip location in the mid-to-distal superior vena cava or Cavoatrial Junction in 100% of cases. The actual time spend on X-ray was 20.1±4.8 min, and the medical cost was 91.5 CNY/pts. No catheter-related venous thrombosis or infection were documented during the 28-day observation period. Operator feedback indicated the technique can reduce the occurrence of malposition with unanimous willingness for continued technique adoption. Conclusion: This preliminary study suggests that integrated magnetic navigation with IC-ECG guidance can correct the tip malposition during PICC insertion process. The technique demonstrates high operator acceptance and procedural feasibility. However, it is necessary to further explore the application effect in China.

Key words: magnetic navigation; Intracardiac Electrocardiogram; tip confirmation system; malposition; Peripherally Inserted Central Catheter