The accuracy and safety of using the electrocardiogram positioning technique in localizing the peripherally inserted central catheter tip position: A systematic review and meta‐analysis

Abstract

Aim We performed a systematic review and meta‐analysis to examine the accuracy and safety of using the electrocardiogram (ECG) positioning technique to localize the peripherally inserted central catheter (PICC) tip position to provide objective evidence for its clinical application. Methods We searched the literature for randomized controlled trials evaluating the diagnostic analysis of using electrocardiograms to localize PICC tip positions in the MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO databases. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Results This systematic review identified 9 studies (N = 3,194 patients). Overall, the results of the meta‐analysis revealed that, for patients in whom the ECG positioning method was used compared with patients in whom the landmark positioning method was used, the RR for accurate catheter tip positioning was RR = 1.17, and the difference was statistically significant. The RR for the incidence of complications was RR = 0.28, and the difference was statistically significant. Conclusions The application of ECGs in PICC tip positioning can improve the accuracy of catheter tip positioning and reduce the incidence of related complications.

Assessing pripherally inserted central catheter tip location in multiple postures: A case report

“… 2 Most studies have focused on verifying the tip location by comparing several technologies, such as intracavitary electrocardiography, echocardiographic techniques, and chest radiography. 3 , 4 , 5 The former two methods are proposed in recent guidelines and widely used in clinical practice because of the fact that they are an intraprocedural method and are characterized by being safe, easy to use, feasible, and accurate. 6 , 7 However, few studies have focused on the role of posture during PICC placement or tip positioning.…”

A late spontaneous peripherally inserted central catheter migration: two cases series

“…In the second case, the PICC measurement was certainly correct, as evidenced by the intraprocedural control with the intracavitary ECG method [ 9 ] and by a subsequent chest CT performed for other reasons. The causes that in this case determined its dislocation remain undetermined, given that the patient did not report having coughed or vomited.…”

A comparative study on the tip position of peripherally inserted central catheter inserted at two forward P-wave amplitudes by intracavitary electrocardiogram in cancer patients

“…Studies had also shown that the risk of catheter-related thrombosis increases seven times when the catheter tip was located in the middle or upper third of the SVC (13). At present, most studies confirmed that the PICC tip position located in the lower third of the SVC or the CAJ is considered as a suitable position (14,15). The CAJ is the ideal position for the catheter tip, where the blood flow is greatest and thrombosis risk is the lowest (16,17).…”