Abstract
BackgroundIntracavitary 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.AimsTo determine whether IC ECG-guided PICCs provide more accurate positioning of catheter tips compared to conventional anatomical landmarks in patients with cancer undergoing chemotherapy.MethodsIn 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.ResultsIn 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.ConclusionsOur 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.
Highlights
Chemotherapy as a routine treatment option for patients with cancer is usually administrated intravenously using a peripherally inserted central catheter (PICC) [1,2,3,4,5]
In the Intracavitary electrocardiogram (IC ECG)-guided group, the first-attempt success rate was 89.2% (95% confidence interval [confidence intervals (CIs)], 86.5% to 91.9%), which was significantly higher than 77.4% in the anatomical landmark group (P < 0.0001)
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
Summary
Chemotherapy as a routine treatment option for patients with cancer is usually administrated intravenously using a peripherally inserted central catheter (PICC) [1,2,3,4,5]. Since catheters placed outside of the cavo-atrial junction (CAJ) are potentially associated with higher risk of thrombosis and infection [1,2,3], it is essential that the catheter tip is in an ideal position when PICCs used for chemotherapy are left in place for several weeks or months [6, 7]. Pittiruti et al [13, 14] agreed that for chemotherapy, the tip should preferably be placed in the lower third of the SVC. Chinese nursing practice standards require that the catheter tip be placed in the SVC [15]. Data Availability Statement: All relevant data are within the paper and its Supporting Information files
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