The accuracy and safety of using the electrocardiogram positioning technique in localizing the peripherally inserted central catheter tip position: A systematic review and meta-analysis

Abstract

Aim: We performed a systematic review and meta-analysis to examine the accuracy and safety of using the electrocardiogram (ECG) positioning technique to localize the peripherally inserted central catheter (PICC) tip position to provide objective evidence for its clinical application. Methods: We searched the literature for randomized controlled trials evaluating the diagnostic analysis of using electrocardiograms to localize PICC tip positions in the MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO databases. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Results: This systematic review identified 9 studies (N = 3,194 patients). Overall, the results of the meta-analysis revealed that, for patients in whom the ECG positioning method was used compared with patients in whom the landmark positioning method was used, the RR for accurate catheter tip positioning was RR = 1.17, and the difference was statistically significant. The RR for the incidence of complications was RR = 0.28, and the difference was statistically significant. Conclusions: The application of ECGs in PICC tip positioning can improve the accuracy of catheter tip positioning and reduce the incidence of related complications.