Key result
Intracavitary electrocardiogram (IC-ECG) guidance for PICC placement had a higher success rate on the first attempt and lower total complications compared with landmark guidance (P<0.00001).
Why the study?
The accuracy of intracavitary electrocardiogram guidance for PICC tip localization and associated complications remained controversial.
Does intracavitary electrocardiogram guidance improve the success rate on the first attempt in patients undergoing peripherally inserted central catheter placement?
Meta-Analysis
Does intracavitary electrocardiogram guidance improve the success rate on the first attempt in patients undergoing peripherally inserted central catheter placement?
p-value: p=< 0.00001
IC-ECG guidance for PICC placement is associated with a higher first-attempt success rate and fewer complications compared to landmark guidance.
Supports IC-ECG adoption for PICC placement; extends Level 1 evidence favoring ECG guidance over landmark technique.
BACKGROUND: The intracavitary electrocardiogram (IC-ECG) localization technique has been widely used in peripherally inserted central catheter (PICC) placement. However, the accuracy of IC-ECG on PICC tip localization and complications remains controversial. The purpose of this work is to evaluate the clinical efficacy and safety of IC-ECG on PICC placement. MATERIALS AND METHOD: We retrieved randomized control trials from PubMed, Web of Science, Cochrane Library, EMBASE, and CNKI databases published before October 30, 2024. Patients guided by IC-ECG technology or landmark, and then used radiography to confirm the tip position, regardless of age, race, nationality, and region. Interventions other than IC-ECG or landmark were excluded. We used the Cochrane Bias Risk Assessment tools version 2 to evaluate the quality of enrolled trials. The Grading of Recommendations Assessment, Development, and Evaluation Statements online tool was used to determine the certainty of the evidence. The primary outcome was the success rate on the first attempt. RESULTS: < 0.00001). Total complications and phlebitis events decreased in the IC-ECG group compared with the landmark group. The mean procedure time, thrombogenesis, infection, and arrhythmia in the IC-ECG group are not statistically significant compared with the landmark group. Trial-sequential analysis (TSA) of the results indicate that sufficient events had been observed in the outcomes in success rate on first attempt, overall successful rate, total complications, phlebitis events, and infection events. CONCLUSION: The IC-ECG guided method has a higher success rate on the first attempt and lower total complication for catheter tip localization in PICC placement. IC-ECG may be considered the preferred method for accurate catheter tip placement. (PROSPERO registration number, CRD42023456651).
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Zeng et al. (2025) conducted a meta-analysis in Peripherally inserted central catheter (PICC) placement. Intracavitary electrocardiogram (IC-ECG) guidance vs. Landmark guidance was evaluated on Success rate on the first attempt (p=< 0.00001). Intracavitary electrocardiogram (IC-ECG) guidance for PICC placement had a higher success rate on the first attempt and lower total complications compared with landmark guidance (P<0.00001).
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