Tip confirmation using electrocardiography reduces thrombosis risk compared to fluoroscopy for insertion of peripherally inserted central catheters-the terrific study. an analysis of 42687 patients

Abstract

Background: Peripherally inserted central catheter (PICC) tip placement at the cavo-atrial junction has been associated with reduced catheterrelated thrombosis. Electrocardiographic (EKG) tip confirmation is convenient, economical and avoids radiation, however its direct correlation to reducing deep vein thrombosis (DVT) compared to radiological tip confirmation (X-Ray, fluoroscopy) is unknown. Methods: Prospectively collected PICC data of adult, medical inpatients in 52 Michigan hospitals were analyzed. Patients' medical records were reviewed to verify method of tip confirmation (EKG vs. radiological). Radiological tip confirmation was defined as PICC placed at the bedside with post insertion X-Ray to confirm tip position. Descriptive statistics described group characteristics. Multivariate models (clustering by hospital and multiple PICCs within same patient) were fit to assess PICC-DVT when EKG-vs. radiology were used. Results: A total of 42,687 PICCs (21,098 radiology confirmed vs. 21,589 EKG) were included in the analyses. Patients receiving EKG to confirm PICC tip position had fewer comorbidities than patients with PICC placed at the bedside and retrospective x-ray. Compared to radiology confirmed PICC tip placement, EKG-placed PICCs were more frequently inserted by vascular access nurses (96%) and in academic facilities (71.1% vs. 48.7%). Overall DVT complications occurred in 594 (1.3%) PICCs. Larger catheter size (OR = 1.32 [95% CI 0.93-1.90] per unit increase in size), history of DVT and cancer was associated with an increased risk of DVT (OR = 2.00 [95% CI 1.65-2.43] and OR = 1.62 [95% CI 1.16-2.26], respectively). Following risk adjustment, EKG confirmation was associated with a significant reduction in PICC-DVT, compared with radiological (OR = 0.74, 95% [CI = 0.58-0.93, p = 0.0098]). Conclusion: EKG-placed PICCs led to significant reduction in PICC-DVT. Further efficacy randomized controlled trials are needed to confirm these results, particularly in high risk patients (history of DVT or cancer) and other vulnerable populations (pediatrics and neonates). Greater adoption of this method for PICC insertion might improve patient safety and reduce healthcare costs.L6341221062021-02-15 <br />