Insertion of peripherally inserted central catheters with intracavitary electrocardiogram guidance: A randomized multicenter study in China. Issue 5 (September 2019)

• Record Type: Journal Article
• Authors: Yin, Yu-Xia; Gao, Wei; Li, Xu-Ying; Lu, Wei; Deng, Qian-Hong; Zhao, Cui-Yun; Liu, Xue-Rong; Zhou, Chao; Hou, Wen-Bo; Lu, Shou-Tao; Liu, Guang; Wang, Lu-Ning; Li, Mao-Quan; Zhang, Hai-Jun
• Is Part Of: Journal of vascular access. Volume 20:Issue 5(2019)
• Page Start: 524
• Page End: 529
• Publication Date: 2019-09
• Subjects: Peripherally inserted central catheters -- intracavitary electrocardiogram -- tip location -- ultrasound guidance; Arterial catheterization -- Periodicals; Intravenous catheterization -- Periodicals; 612.13
• DOI: 10.1177/1129729818819732
• Languages: English
• ISSNs: 1129-7298

Abstract

Introduction: Ultrasound-guided venipuncture and tip location by intracavitary electrocardiogram have many advantages during the insertion of peripherally inserted central catheters, both in terms of safety and cost-effectiveness. Recently, a new tip-conductive peripherally inserted central catheters and new Doppler ultrasound device integrated with intracavitary electrocardiogram have been introduced into clinical practice in China. A randomized multicenter study (clinical trial no. NCT03230357) was performed to verify the feasibility and accuracy of intracavitary electrocardiogram, as performed with this new peripherally inserted central catheters and device. Methods: Our study enrolled a total of 2250 adult patients in 10 different Chinese hospitals. The patients were randomly assigned to either the study group (intracavitary electrocardiogram) or the control group (anatomical landmark guidance) in a 2:1 allocation. Ultrasound was used in both groups for venipuncture and tip navigation. All patients underwent chest X-ray after the procedure to verify the position of the catheter tip. Results: No insertion-related complications were reported in either group. In the study group, first-attempt successful tip location was 91.7% (95% confidence interval: 90.3%–93.1%), significantly higher than 78.9% (95% confidence interval: 76.0%–81.9%) observed in the control group (p < 0.001). As evaluated by post-procedural chest X-ray, tip location in the study group had a sensitivity of 99.3% (95% confidence interval: 98.8%–99.7%), significantly higher than 86.8% (95% confidence interval: 84.4%–89.2%) observed in the anatomical landmark group (p < 0.001). Conclusion: These results indicated that during peripherally inserted central catheters insertion in adult patients, tip location with intracavitary electrocardiogram guidance, as carried out by a new tip-conductive peripherally inserted central catheters and intracavitary electrocardiogram integrated ultrasound device, was more effective and more accurate than tip location using anatomical landmarks.