title: Evaluation of the correct position of peripherally inserted central catheters: anatomical landmark vs. electrocardiographic technique.
abstract: OBJECTIVE
  The purpose of this study is to verify as early as possible the correct positioning of the peripherally inserted central catheter (PICC) tip in order to reduce complications due to possible malpositioning. The ECG-guided technique proved to be reliable, easy to carry out, straightforward, low-cost and allows us to recognize an incorrect or a suboptimal positioning throughout the procedure. The purpose of this study is to compare two methods used during the PICC insertion so as to prevent catheter malpositioning; the first study estimates the catheter length by the landmark method (based on cutaneous anatomical landmarks, CALs) with the addition of the postprocedural verification of tip location by chest X-Ray (CxR), whereas the second method of intraprocedural tip location is based on the observation of the morphological variations of the P wave (ECG-guided technique) with the addition of the postprocedural verification by CxR.
  
  
  METHODS
  From 2010 to 2012, 90 PICCs were positioned, 48 using the anatomical landmarks and 42 using the ECG technique.
  
  
  RESULTS
  Twenty-five percent of the catheters positioned with the anatomical landmark technique did not reach the correct position of the tip in SVC; of these, 6.25% were placed in an aberrant position and others in a sub-optimal position.Of the 42 PICCs positioned with the ECG technique, only in three cases (equal to 7.14%), a suboptimal position of the tip was observed, whereas there was no case of aberrant positioning.
  
  
  CONCLUSIONS
  The ECG technique represents an accurate, low-cost and safe technique to verify the correct positioning of the tip. The use of the ECG allowed a more correct positioning in terms of catheter tip-carina distance and catheter tip-tracheobronchial angle, and in no patient was it necessary to place a catheter again.
authors.affiliation: 1 Department of Anesthesiology, Central Hospital of Bolzano, Bolzano - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Baldinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Capozzoli
authors.forename: Roberta
authors.initials: R
authors.lastname: Pedrazzoli
authors.forename: Natascia
authors.initials: N
authors.lastname: Marzano
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D016275:Atrial Function; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D062905:Central Venous Catheters; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures