title: Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer: A randomized open-label controlled multicenter study.
abstract: BACKGROUND
  Intracavitary electrocardiogram (IC ECG) guidance emerges as a new technique for peripherally inserted central catheters (PICCs) placement and demonstrates many potential advantages in recent observational studies.
  
  
  OBJECTIVE
  To determine whether IC ECG-guided PICCs provide more accurate positioning of catheter tips compared to conventional anatomical landmarks in patients with cancer undergoing chemotherapy.
  
  
  METHODS
  In this multicenter, open-label, randomized controlled study (ClinicalTrials.gov number, NCT02409589), a total of 1,007 adult patients were assigned to receive either IC ECG guidance (n = 500) or anatomical landmark guidance (n = 507) for PICC positioning. The confirmative catheter tip positioning x-ray data were centrally interpreted by independent radiologists. All reported analyses in the overall population were performed on an intention-to-treat basis. Analyses of pre-specified subgroups and a selected large subpopulation were conducted to explore consistency and accuracy.
  
  
  RESULTS
  In the IC ECG-guided group, the first-attempt success rate was 89.2% (95% confidence interval [CI], 86.5% to 91.9%), which was significantly higher than 77.4% (95% CI, 73.7% to 81.0%) in the anatomical landmark group (P < 0.0001). This trend of superiority of IC ECG guidance was consistently noted in almost all prespecified patient subgroups and two selected large subpopulations, even when using optimal target rates for measurement. In contrast, the superiority nearly disappeared when PICCs were used via the left instead of right arms (interaction P-value = 0.021). No catheter-related adverse events were reported during the PICC intra-procedures in either group.
  
  
  CONCLUSIONS
  Our findings indicated that the IC ECG-guided method had a more favorable positioning accuracy versus traditional anatomical landmarks for PICC placement in adult patients with cancer undergoing chemotherapy. Furthermore, there were no significant safety concerns reported for catheterization using the two techniques.
authors.affiliation: The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Yuan
authors.affiliation: The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Rongmei
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Nursing, Jiangsu Cancer Hospital, Nanjing, Jiangsu Province, China.
authors.forename: Aifeng
authors.initials: A
authors.lastname: Meng
authors.affiliation: The Comprehensive Cancer Centre of People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu Province, China.
authors.forename: Yuling
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Medical Oncology, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Xiancui
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Medical Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Medical Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Zhenzhu
authors.initials: Z
authors.lastname: Qiu
authors.affiliation: Department of Medical Oncology, Nanjing Jinling Hospital, Nanjing, Jiangsu Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Qi
authors.affiliation: Department of Nursing, Jiangsu Cancer Hospital, Nanjing, Jiangsu Province, China.
authors.forename: Chuanying
authors.initials: C
authors.lastname: Chen
authors.affiliation: The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Medical Imaging, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Minyi
authors.initials: M
authors.lastname: Qin
authors.affiliation: The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Kong
authors.affiliation: Department of Nursing, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D056888:Patient Positioning; D011237:Predictive Value of Tests