ECG or X-ray as the 'gold standard' for establishing PICC-tip location?

Recently there has been an increase in evidence that the tip position of a peripherally inserted central catheter (PICC) needs to be accurately placed in the lower third of the superior vena cava at the junction with the right atrium in order to minimise potential complications ( Royal College of Nursing, 2010 ; Infusion Nurses Society, 2011 ). The current 'gold standard' practice of performing a chest X-ray post-insertion of PICC can be fraught with complications with regard to accurately placing the PICC in this position. The purpose of this evaluation is to discuss how using an electrocardiogram-guided PICC placement system may be a preferable method with which to accurately measure the exact position of the PICC within the venous system.

[1]  Gemma Oliver,et al.  Evaluation of an electrocardiograph-based PICC tip verification system. , 2013, British journal of nursing.

[2]  L. Kelly.  A practical guide to safe PICC placement. , 2013, British journal of nursing.

[3]  T. See,et al.  Defining peripherally inserted central catheter tip position and an evaluation of insertions in one unit , 2013, Anaesthesia.

[4]  L. De Simone,et al.  The Intracavitary ECG Method for Positioning the Tip of Central Venous Catheters: Results of an Italian Multicenter Study , 2012, The journal of vascular access.

[5]  G. Scoppettuolo,et al.  The Electrocardiographic Method for Positioning the Tip of Central Venous Catheters , 2011, The journal of vascular access.

[6]  W. Murphy,et al.  Central venous line placement in the superior vena cava and the azygos vein: differentiation on posteroanterior chest radiographs. , 2011, AJR. American journal of roentgenology.

[7]  G. Hejblum,et al.  An integrated approach for prescribing fewer chest x-rays in the ICU , 2011, Annals of intensive care.

[8]  J. Waisberg,et al.  Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication. , 2010, Journal of pediatric surgery.

[9]  D. McDonnall,et al.  Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters. , 2009, Journal of electrocardiology.

[10]  B. Hill,et al.  Precision in Central Venous Catheter Tip Placement: A Review of the Literature , 2010 .

[11]  Nadine Nakazawa.  Challenges in the Accurate Identification of the Ideal Catheter Tip Location , 2010 .

[12]  N. Moureau,et al.  Electrocardiogram (EKG) Guided Peripherally Inserted Central Catheter Placement and Tip Position: Results of a Trial to Replace Radiological Confirmation , 2010 .

[13]  M. Siegel,et al.  Routine daily vs on-demand chest radiographs in intensive care , 2009, The Lancet.

[14]  P. Arand,et al.  Noninvasive computerized acoustic cardiographic prediction of pulmonary hypertension , 2009 .

[15]  C. M. Jones,et al.  Imaging of the complications of peripherally inserted central venous catheters. , 2009, Clinical radiology.

[16]  J. Macfie,et al.  ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). , 2009, Clinical nutrition.

[17]  J. Steenbeck,et al.  Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position? , 2008, Chest.

[18]  G. Scoppettuolo,et al.  The EKG Method for Positioning the Tip of PICCs: Results from Two Preliminary Studies , 2008 .

[19]  G. Pestel,et al.  Atrial electrocardiogram for verification of correct central venous catheter placement. , 2007, Anesthesia and analgesia.

[20]  W. Schummer,et al.  Avoidance of central venous catheterization malposition by ECG guidance. , 2007, Critical care medicine.

[21]  P. Szmuk,et al.  The Accuracy of Electrocardiogram-Controlled Central Line Placement , 2007, Anesthesia and analgesia.

[22]  J. David,et al.  Is ECG‐guidance a helpful method to correctly position a central venous catheter during prehospital emergency care? , 2005, Acta anaesthesiologica Scandinavica.

[23]  Marcus J Schultz,et al.  Can We Abandon Daily Routine Chest Radiography in Intensive Care Patients? , 2005, Journal of intensive care medicine.

[24]  C. Keyl,et al.  Central venous catheter placement: comparison of the intravascular guidewire and the fluid column electrocardiograms , 2004, European journal of anaesthesiology.

[25]  T. Vesely.  Central venous catheter tip position: a continuing controversy. , 2003, Journal of vascular and interventional radiology : JVIR.

[26]  P. Dionisio,et al.  The Placement of Central Venous Catheters in Hemodialysis: Role of the Endocavitary Electrocardiographic Trace. Case Reports and Literature Review , 2001, The journal of vascular access.

[27]  D. Richardson,et al.  Catheter Tip Position: A Sign of Things to Come! , 2001 .

[28]  A. Bodenham,et al.  Safe placement of central venous catheters: where should the tip of the catheter lie? , 2000, British journal of anaesthesia.

[29]  J. Heffner,et al.  MRI of central venous anatomy: implications for central venous catheter insertion. , 1998, Chest.

[30]  R. Parkinson,et al.  Establishing an ultrasound guided peripherally inserted central catheter (PICC) insertion service. , 1998, Clinical radiology.

[31]  H L Kundel,et al.  Routine portable chest radiographs in the medical intensive care unit: effects and costs. , 1997, Critical care medicine.

[32]  A. Bankier,et al.  Azygos Arch Cannulation by Central Venous Catheters: Radiographic Detection of Malposition and Subsequent Complications , 1997, Journal of thoracic imaging.

[33]  P. Lui,et al.  Incidence and risk factors of guidewire-induced arrhythmia during internal jugular venous catheterization: comparison of marked and plain J-wires. , 1996, Journal of clinical anesthesia.

[34]  D. Korones,et al.  Right atrial thrombi in children with cancer and indwelling catheters. , 1996, The Journal of pediatrics.

[35]  J. Wehner,et al.  Complications of long arm-catheters: a randomized trial of central vs peripheral tip location. , 1996, JPEN. Journal of parenteral and enteral nutrition.

[36]  W. L. Scott.  Central Venous Catheters: An Overview of Food and Drug Administration Activities , 1995 .

[37]  G. Scheffer,et al.  Central venous catheter placement using the ECG-guided Cavafix-Certodyn SD catheter. , 1994, Journal of clinical anesthesia.

[38]  Francis Kr,et al.  Avoiding complications and decreasing costs of central venous catheter placement utilizing electrocardiographic guidance. , 1992 .

[39]  W. Engelhardt,et al.  [ECG-controlled placement of central venous catheters in patients with atrial fibrillation]. , 1989, Der Anaesthesist.

[40]  H. Hellerstein,et al.  Recording of Intracavity Potentials Through a Single Lumen, Saline Filled Cardiac Catheter , 1949, Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine.