title: Effectiveness of electrocardiographic guidance in CVAD tip placement.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Foundation Year Doctor, The University of Aberdeen, Scotland.
authors.forename: Graham
authors.initials: G
authors.lastname: Walker
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Chan
authors.affiliation: Senior Research Fellow.
authors.forename: Evan
authors.initials: E
authors.lastname: Alexandrou
authors.affiliation: Nursing Director for Research, Royal Brisbane and Women's Hospital, Australia.
authors.forename: Joan
authors.initials: J
authors.lastname: Webster
authors.forename: Claire
authors.initials: C
authors.lastname: Rickard
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D015641:Radiography, Interventional
keywords: Central venous access device; Central venous catheter; Electrocardiogram