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.
Chen Yu, Luo Shulan, Wang Juan and 2 others
PMID 34132498WHAT IT FOUND
ECG guidance placed PICC tips more accurately than landmark measurement and was associated with fewer complications in 9 RCTs, but chest X-ray confirmation was still used.
Do not omit chest X-ray when the ECG P-wave is absent.
Key findings
01Across 9 trials, ECG localization with chest X-ray confirmation improved PICC tip placement accuracy compared with landmark measurement with chest X-ray confirmation (RR 1.17, 95% CI 1.04 to 1.32, N 3,194).
02Across 7 trials, ECG localization with chest X-ray confirmation reduced the incidence of complications compared with landmark measurement with chest X-ray confirmation (RR 0.28, 95% CI 0.14 to 0.55, N 2049).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 9 RCTs were included, and several had small samples, so the pooled results are not definitive. Therapists and participants were not blinded in any included study, which can affect how catheters are placed and adjusted. Some studies lacked concealed allocation, blind assessors, or intention-to-treat analysis. The included studies varied in method and sample, and heterogeneity was present. Some studies did not describe the ECG positioning technique in enough detail to guide practice. GRADE rated the evidence medium quality, not high.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that ECG guidance removes the need for chest X-ray confirmation. The included trials used chest X-ray to confirm tip position, and the review says X-ray is needed when a characteristic P-wave is not observed.