Apparatus and method for catheter navigation and tip location
Devices and methods obtain and use endovascular electrograms in a number of clinical applications and settings. In one embodiment, methods for triggering analysis of an endovascular ECG waveform are based on the detection of a peak in a skin-based ECG waveform in order to determine a location of an indwelling medical device, such as a catheter. In another embodiment, the position of a catheter or other medical device within the vasculature can be determined by analysis of the energy profile of a detected P-wave. In yet other embodiments, magnetic connecting devices are used for establishing an operable connection through a sterile field.
1. A method for locating an indwelling medical device within a body of a patient, the method comprising:
placing a skin electrode on the body of the patient;
inserting the medical device into the body of the patient, the medical device including a medical device electrode designed to sense an endovascular ECG signal;
detecting a skin ECG waveform via the skin electrode;
detecting an endovascular ECG waveform via the medical device electrode;
locating a position of the medical device in the body of the patient;
displaying the skin ECG waveform and the endovascular ECG waveform in a first window of a display in real-time; and
displaying a frozen view of the skin ECG waveform and the endovascular ECG waveform in a second window of the display.
2. The method for locating according to claim 1 , wherein the skin ECG waveform and the endovascular ECG waveform in real time are displayed in a time-synchronized manner, and wherein the display is included on a single user interface.
3. The method for locating according to claim 2 , wherein the medical device electrode is positioned on a distal end of the medical device, wherein following the inserting step, the medical device electrode is within a vasculature of the patient.
4. The method for locating according to claim 1 , further comprising:
detecting a first peak in the skin ECG waveform;
triggering analysis of the endovascular ECG waveform when the first peak is detected;
detecting a second peak in the endovascular ECG waveform, the second peak including a P-wave peak; and
determining a position of a portion of the medical device based on a characteristic of the second peak, including determining the portion of the medical device to be above and moving toward a sino-atrial node of a heart of the patient when an amplitude of the P-wave is positive and is increasing in positive amplitude.
5. The method for locating according to claim 4 , further comprising iteratively detecting the second peak, wherein determining a position further comprises determining the position of the portion of the medical device based on a change of the characteristic as the second peak is iteratively detected.
6. The method for locating according to claim 4 , wherein the first peak includes an R-wave peak and a P-wave peak is absent in the skin ECG waveform due to arrhythmia.
7. The method for locating according to claim 4 , wherein the step of triggering the analysis of the endovascular ECG waveform is executed automatically by a processor coupled to the display.
8. The method for locating according to claim 1 , further comprising:
depicting on the display a location icon representing the position of the medical device in the body of the patient; and
updating the location icon according to iteratively determining the position of the medical device in the body of the patient.
9. The method for locating according to claim 8 , wherein depicting the location icon comprises depicting the location icon atop a representative image of a heart of the patient.
10. The method for locating according to claim 1 , wherein the display is on a mobile phone or handheld device, and wherein the skin ECG waveform and the endovascular ECG waveform are transmitted to the mobile phone or handheld device via wireless transfer from the skin electrode and the medical device electrode.
11. A method for locating according to claim 1 , further comprising:
detecting a first peak in the skin ECG waveform;
triggering analysis of the endovascular ECG waveform when the first peak is detected;
detecting a second peak in the endovascular ECG waveform, the second peak including a P-wave peak; and
determining a position of a portion of the medical device based on a characteristic of the second peak, including determining the portion of the medical device to be above and moving away from a sino-atrial node of a heart of the patient when an amplitude of the P-wave is negative and is increasing in negative amplitude.
12. The method for locating according to claim 11 , further comprising iteratively detecting the second peak, wherein determining a position further comprises determining the position of the portion of the medical device based on a change of the characteristic as the second peak is iteratively detected.
13. The method for locating according to claim 11 , wherein the first peak includes an R-wave peak and a P-wave peak is absent in the skin ECG waveform due to arrhythmia.
14. The method for locating according to claim 11 , wherein the step of triggering the analysis of the endovascular ECG waveform is executed automatically by a processor coupled to the display.