Walker, G., Alexandrou, E., Rickard, C. M., Chan, R. J. and Webster, J. (2015) Effectiveness of electrocardiographic guidance in CVAD tip placement. British Journal of Nursing, 24(Sup14), S4-S12. (doi: 10.12968/bjon.2015.24.Sup14.S4) (PMID:26203700)
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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. Conclusion: 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.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Walker, Dr Graham |
Authors: | Walker, G., Alexandrou, E., Rickard, C. M., Chan, R. J., and Webster, J. |
College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
Journal Name: | British Journal of Nursing |
Publisher: | M.A. Healthcare |
ISSN: | 0966-0461 |
ISSN (Online): | 2052-2819 |
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