Effectiveness of electrocardiographic guidance in CVAD tip placement

Walker, Graham; Chan, Raymond Javan; Alexandrou, Evan; Webster, Joan; Rickard, Claire M

doi:10.12968/bjon.2015.24.sup14.s4

Cited by 32 publications

(37 citation statements)

References 22 publications

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“…Moreover, radiological confirmation of success at the end of the procedure would have allayed anxiety further. Once the precision of the ECG-guided technique is established, confirmation with chest radiography will not be necessary, and the cost of the procedure will be correspondingly less; Bream and Gu 21 and Walker et al 22 have also suggested the same.…”

Section: Discussionmentioning

confidence: 99%

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

Li¹,

Jiao²,

Zhang³

et al. 2018

Indian Journal of Medical Research

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Background & objectives:The peripherally inserted central catheter (PICC) has the advantages of higher safety, lower infection rate and longer retention time than peripherally inserted catheter. This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique.Methods:Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and after the procedure; medical cost and incidence of complications at one week, three months and six months after PICC insertion.Results:Accurate tip location was achieved in 99.30 per cent in the ECG test group vs 92.30 per cent in the control group (P <0.001). At 24 h after the procedure, the anxiety level was significantly lower in the ECG test group. The presence of thrombogenesis was significantly lower in the ECG test group at both three months and six months after the procedure (P=0.04 and P=0.03, respectively).Interpretation & conclusions:The ECG-guided PICC tip location technique was accurate and caused fewer procedure-related complications and less anxiety in patients compared to chest radiography tip location technique. Radiographic confirmation of PICC tip position may not be needed when ECG guidance is used and thus it can help avoid radiation exposure.

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Section: Discussionmentioning

confidence: 99%

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

Li¹,

Jiao²,

Zhang³

et al. 2018

Indian Journal of Medical Research

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“…For these reasons, the use of the method of intracavitary electrocardiography (IC-ECG) for real-time verification of the tip position appears to be particularly appropriate in preterm infants. Some studys [1,2,3] have already demonstrated the safety and feasibility of IC-ECG in the positioning of central venous accesses in adult patients and children [4,5] and have confirmed its accuracy compared with the postoperative chest X-ray. This method has also been used in newborns: Neubauer [6,7] reported the application of this technique in this particular patent population.…”

Section: Introductionmentioning

confidence: 89%

Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases

He¹

2019

AJNS

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A tertiary neonatal intensive care unit (NICU) in China has carried out a study investigating the safety and accuracy of intracavitary electrocardiogram (IC-ECG) guidance in PICC tip placement in preterm infants. From October 2015 to September 2018, IC-ECG-guidance was applied in 327 preterm infants in our NICU. The positioning of the PICC was performed under ECG-guidance and subsequently assessed by chest X-ray. The frequency of correct ECG-guided PICC-placement in one single attempt, premature infants gender, weight, weeks' gestational age at PICC insertion was recorded. 327preterm infants(207 male and 120 female)were included in the study with a gestation of 31.3 weeks (25.3 to 36.8) and birth weight of 1498 g (600 to 2560). 327 PICCs tip placement was guided with IC-ECG, all concordant with chest X-ray. 313 (95.7%) were correctly positioned, 228 (72.3%) were correctly positioned on the first attempt, 5 were incorrectly identified to have a short line and 9 were malpositioned. The most commonly punctured vein was the basilic vein (n=228), followed by the superficial temporal vein (n = 31), the axillary vein (n = 25). For 3 years IC-ECG method has proved to be a simple, safe, quick method to assess the correct positioning of the PICC in preterm infants. This is a reliable technique, performing real-time manipulation without any complications.

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“…As a result, the catheter tip needs repeated debugging after ectopia, and the incidence of mechanical vein inflammation, catheter-related bloodstream infection, thrombosis, lymphatic leakage and other complications can be increased [32]. For patients suffered from the chest and ascites diseases, when the catheter is conveyed to the predicted length, the tip may have shifted to the right atrium, and serious complications may be lead to, such as heart rate disorders, heart thrombosis, pericardial tamponade and pericardial rupture that endanger the lives of patients [33]. At present, PICC catheter tip positioning approach used in the clinical combines X-ray film with the estimated length in vitro.…”

Section: The Application Of Atrial Electro-gram To Picc Catheter Tip mentioning

confidence: 99%

Meta-Analysis of Atrial Electro-Gram Applied to PICC Catheter Tip Positioning

Song¹,

Wang²,

Hu³

2017

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Objective: Assess the location effect of the atrial electrogram in the PICC catheter tip. Method: Make online research in the CNKI, CBM, Wanfang, VIP, Database, Cochrane Library, JBI Library, PubMed, Ovid, Springer, Web of science, MEDLINE database to collect the randomized controlled trial data of using the atrial electrogram to locate the PICC catheter tip. When making the online research, only the data to November 20, 2016 can be searched out. Two researchers independently select the literature and information, make quality assessment, and then use the RevMan 5.2 software to make Meta analysis. Result: 16 random tests are done. The Meta analysis results show that compared with the traditional X ray chest radiograph location method, the atrial electrogram can increase the accuracy rate of the location of the catheter tip [RR = 1.13, 95%CI (1.07, 1.19), P < 0.00001]; it can decrease the incidence rate of related complications [RR = 0.37, 95%CI (0.21, 0.66), P < 0.0008]; and it can save the catheter placing time .57), P < 0.0001]. Conclusion: The atrial electrogram can increase the accuracy rate of the location of the catheter tip, decrease the incidence rate of related complications and save the catheter placing time. Therefore, it is worthy of clinical application.

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Effectiveness of electrocardiographic guidance in CVAD tip placement

Cited by 32 publications

References 22 publications

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

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

Outcome of Intracavitary Electrocardiogram Guidance in PICC Tip Placement in Preterm Infants: A Single-center Experience of 327 Cases

Meta-Analysis of Atrial Electro-Gram Applied to PICC Catheter Tip Positioning

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