Clinical evaluation of the use of an intracardiac electrocardiogram to guide the tip positioning of peripherally inserted central catheters

Abstract

The use of peripherally inserted central catheters (PICCs) provides important central venous accesses for clinical treatments, tests and monitoring. Compared with the traditional methods, intracardiac electrocardiogram (ECG)-guided method has the potential to guide more accurate tip positioning of PICCs. This study aimed to clinically evaluate the effectiveness of an intracardiac ECG to guide the tip positioning by monitoring characteristic P-wave changes. In this study, eligible patients enrolled September 2011 to May 2012 according to the inclusion and exclusion criteria received the catheterization monitored by intracardiac ECG. Then chest radiography was performed to check the catheter position. The results revealed that, with 117 eligible patients, all bar one patient who died (n = 116) completed the study, including 60 males and 56 females aged 51.2 ± 15.1 years. Most (n = 113, > 97%) had characteristic P-wave changes. The intracardiac ECG-guided positioning procedure achieved correct placement for 112 patients (96.56%), demonstrating 99.12% sensitivity and 100% specificity. In conclusion, the intracardiac ECG can be a promising technique to guide tip positioning of PICCs. However, since the sample size in this study is limited, more experience and further study during clinical practice are needed to demonstrate achievement of optimal catheterization outcomes.

Meta-analysis of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement

“…The total sample size was 434, and it was reported that the tip positioning accuracy of IC-ECG technology was 93.33% (p < 0.01). 6,[19][20][21] A funnel plot analysis was performed on five studies (such as Figure 3). The symmetry of the funnel plot was poor, suggesting that the results are more likely to be affected by publication bias.…”

“…3 Correct tip positioning of PICC is crucial to avoid catheterization-related complications such as migration, venous thrombosis, or arrhythmia. 4 Previously, there were many ways applied to the PICC tip positioning, such as X-ray chest radiograph, which is considered as "gold standards" for assessing catheter position [5][6][7] intracavitary electrocardiogram (IC-ECG) is a new tip positioning technology. Pittiruti and other researchers [8][9][10][11] have confirmed that IC-ECG-guided PICCs tip positioning was safe and accurate.…”

Immediate post‐insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration

“…[5][6][7] Further to this, some describe fastidious extra-atrial positioning of central line tips with the aid of intra-cardiac ECG. 8 In contrast, there are opinions which allow for tips to be located within the right atrium, 9 for example the common practice of intra-atrial placement of central venous haemodialysis catheters. 10 There is, however, general consensus between these two schools of thought regarding the increased risk of vessel perforation by left-sided central line tips positioned at a high angle of incidence to the lateral wall of the superior vena cava (SVC).…”

“…In particular, the intra‐atrial positioning of line tips has been admonished by several groups with reports citing complications of cardiac tamponade, arrhythmias and thrombosis . Further to this, some describe fastidious extra‐atrial positioning of central line tips with the aid of intra‐cardiac ECG …”

A randomized controlled study of bedside electrocardiograph-guided tip location technique & the traditional chest radiography tip location technique for peripherally inserted central venous catheter in cancer patients

“…However, there have been a few studies on the safety and efficacy of bedside ECG-guided PICC tip location in cancer patients. Liu et al 10 and Zhao et al 11 studied 85 and 116 Chinese patients with ECG-guided PICC, respectively, and reported high accuracy of tip localization, but they did not examine the precision of tip location, procedure related anxiety and PICC-associated complications. This study was aimed to explore the accuracy, precision, safety, procedure-related anxiety and complications associated with bedside ECG-guided PICC tip location compared to traditional chest radiography tip location technique.…”