Effectiveness of electrocardiographic guidance in CVAD tip placement

Walker, Graham, Chan, Raymond J., Alexandrou, Evan, Webster, Joan, & Rikard, Claire (2015) Effectiveness of electrocardiographic guidance in CVAD tip placement. British Journal of Nursing, 24(14), pp. 1-7.

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International standard practice for the correct confirmation of the central venous access device is the chest X-ray. The intracavitary electrocardiogram-based insertion method is radiation-free, and allows real-time placement verification, providing immediate treatment and reduced requirement for post-procedural repositioning.


Relevant databases were searched for prospective randomised controlled trials (RCTs) or quasi RCTs that compared the effectiveness of electrocardiogram-guided catheter tip positioning with placement using surface-anatomy-guided insertion plus chest X-ray confirmation. The primary outcome was accurate catheter tip placement. Secondary outcomes included complications, patient satisfaction and costs.


Five studies involving 729 participants were included. Electrocardiogram-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.


The evidence suggests that intracavitary electrocardiogram-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 (PICC) line insertion.

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ID Code: 86519
Item Type: Journal Article
Refereed: Yes
Keywords: Central venous access device, Central venous catheter, Electrocardiogram
DOI: 10.12968/bjon.2015.24.Sup14.S4
ISSN: 0966-0461
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Deposited On: 12 Aug 2015 22:57
Last Modified: 14 Aug 2015 00:54

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