Comparison of ECG Saline Conduction Technique and ECG Wire Based Technique for PICC Insertion: Interim Analysis of Randomized Controlled Trial

Background: Peripherally inserted central catheter (PICC) is a very commonly used medical device. The PICC tip position has been shown to be a major determinant in PICC function and related complications. While the gold standard for optimal tip position is fluoroscopy guidance, recent advances introduce ECG guidance techniques that use no X-ray and might be used in daily practice, as well as a bedside approach. The aim of our study is to compare two ECG techniques for guiding PICC in terms of accuracy of the final position of the catheter tip.

Materials and Methods: A total of 320 participants will be enrolled in a randomized open study using 1:1 allocation. One PICC guidance technique uses ECG signal transmission with saline water and allows external catheter length adjustment (ECG1) while the other technique uses a guidewire for signal transmission thus requiring prior catheter length adjustment (ECG2). These techniques will be compared using chest X-rays (CXR) as a gold standard. Primary outcome is the distance from catheter tip to cavoatrial junction (DCAJ) measured on CXR. Secondary outcomes are length of the outgoing catheter at the entry point and hemostasis time at the puncture site.

Results: A total of 116 patients are included. The interim analysis showed that PICC tip precision in the superior vena cava are equivalent for both techniques (ECG1: DCAJ mean, 1.08 cm; 95% CI: 0.86–1.30; ECG2: DCAJ mean, 0.84 cm; 95% CI: 0.67–1.02; p = 0.16). ECG1 is significantly better than ECG2 regarding the length of the outgoing catheter at the entry point (mean, 0.02 cm vs. 1.84 cm; p < 0.001). ECG2 is significantly better than ECG1 regarding the hemostasis time at the puncture site (no delay hemostasis in achieved in 89% cases vs. 53%; p < 0.001).

Conclusion: ECG guiding technologies are comparable regarding the tip placement. Nevertheless, each technique has an important drawback at PICC insertion point, the length of the outside catheter for ECG2 or a delayed hemostasis ECG1.

Publication History

Article published online:
14 December 2021