The electrocardiographic method for positioning the tip of central venous access device

Yu, Yanfen; Yuan, Lingling

doi:10.1177/1129729819874986

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…Obviously, it is mandatory to check the correct position of the tip in case of symptomatic patients or when there is a well-founded suspicion that something has happened and that the tip of the PICC is no longer in a safe position and therefore the vascular catheter must be repositioned correctly [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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

Caramia,

Recchia,

Santoro

2023

Arch Clin Cases

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A central venous catheter is a flexible catheter that is inserted into a vein and ends close to the superior vena cava. It may be inserted through a vein in the neck, chest, or arm. It’s also called a central venous line or central line. Peripherally inserted central venous catheters (PICCs) are usually implanted in arm veins such as the basilic vein, the brachial veins or in some cases in the cephalic vein. PICCs can remain in place for up to six months or more. If properly managed, they last even more than a year. PICCs offer the advantage of greater safety for infusion of vesicants/irritants and hyperosmolar solutions and enable the administration of antibiotics, prolonged parenteral nutrition, and chemotherapy agents. They are however, associated with some adverse events such as spontaneous late migration. The reasons for these complications are not yet fully understood. There are now established causes and in some cases hypotheses to explain these phenomena. We describe two clinical cases in which apparently correctly positioned PICCs migrated spontaneously from their original position. The identification of the migration of the vascular catheter was accidental in the two patients, and they did not developed complications. One of the two patients had a pacemaker. The remote migration of a PICC is an event that can occur, and the causes are not definitively clarified in all cases.

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Section: Discussionmentioning

confidence: 99%

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

Caramia,

Recchia,

Santoro

2023

Arch Clin Cases

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“…30 A review by Yu and Yuan concluded that using the IC ECG method to place CVADs was more accurate compared to the anthropometric method (OR: 0.21, 95% CI: 0.14–0.34, p < 0.001) however the meta-analysis performed incorporated both randomised and non-randomised studies with significant heterogeneity and risk of selection bias. 31…”

Section: Discussionmentioning

confidence: 99%

“…30 A review by Yu and Yuan concluded that using the IC ECG method to place CVADs was more accurate compared to the anthropometric method (OR: 0.21, 95% CI: 0.14-0.34, p < 0.001) however the meta-analysis performed incorporated both randomised and non-randomised studies with significant heterogeneity and risk of selection bias. 31 Most studies assessing the effect of IC ECG have concentrated on homogenous populations such as neonates and paediatrics or those with cancer, and usually on specific devices (exclusively with PICCs or CICCs). [13][14][15]32 This includes a multicentre randomised trial in 1000 cancer patients across eight hospitals in China comparing IC ECG to anatomical landmark technique using PICCs from a single manufacturer.…”

Section: Discussionmentioning

confidence: 99%

A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement

et al. 2022

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Background: Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. Methods: Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG ( n = 172) or traditional ( n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. Results: Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9–24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference–19.9 min (95% CI–14.6 to −34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. Conclusions: Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. Trial registration: This trial is registered at the Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au ). The registration number is ACTRN12620000919910.

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“…Furthermore, repeating the CXR to confirm correct positioning increases both the dose of radiation exposure and the cost involved. 9 , 12 , 13 It is also not a feasible option in the theatre setting during the peri-operative period.…”

Section: Introductionmentioning

confidence: 99%

Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position

Man

Wentzel

Rooyen

et al. 2023

South African Journal of Radiology

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Background: Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively.Objectives: This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a ‘bubble test’ to detect malposition and pneumothorax.Method: Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the ‘bubble test’ and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR.Results: Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3–6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18–56 min) (p 0.0001).Conclusion: This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition.Contribution: Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.

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The electrocardiographic method for positioning the tip of central venous access device

Cited by 5 publications

References 34 publications

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

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

A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement

Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position

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