Effectiveness of electrocardiographic guidance in CVAD tip placement

Background: International standard practice for the correct confirmation of the central venous access device is the chest X-ray. The intra-cavitary electrocardiographic-based insertion method is radiation-free, and allows real-time placement verification, providing immediate treatment and reduced requirement for post-procedural repositioning. Methods: Relevant databases were searched for prospective randomised control trials (RCTs) or quasi RCTs that compared the effectiveness of electrocardiographic-guided catheter tip positioning and confirmation with chest X-ray (confirmation using surface anatomy guided insertion. The primary outcome was accurate catheter tip placement. Secondary outcomes included complications, patient satisfaction and costs. Results: Five studies involving 729 participants were included. Electrocardiographic-guided insertion was more accurate than surface anatomy guided insertion [odds ratio: 8.3; [95% confidence interval (CI) 1.38; 50.07; p=0.02]]. There was a lack of reporting on complications, patient satisfaction and costs. Conclusion: The evidence suggests that intracavitary electrocardiographic-based positioning is superior to surface anatomy guided positioning of central venous access devices, leading to significantly more successful placements. This technique could potentially remove the requirement for post procedural chest X-ray, especially during peripherally inserted central catheter line insertion