http://worldcat.org/entity/work/id/2255714976

Electrocardiograms versus X-rays for guided placement of central venous catheter tips a review of clinical and cost-effectiveness

Central venous catheters (CVCs) are often used to deliver drugs, supply nutrients, or draw blood samples in some severely ill patients. A peripherally inserted central venous catheter is a type of central venous line. During placement of the CVC, the correct position of the tip is of paramount importance and should be verified immediately after placement before infusion to avoid any catheter-related complications. Post-procedural chest x-ray is a commonly used method for verification of the CVC tip position. X-rays, however, have some limitations as they are not readily available until the end of the surgical procedure, the method is not 100% accurate and there is a risk of patients being exposed to radiation. Moreover, when a misplacement of the CVC tip is detected by chest x-ray, a further procedure is required to reposition the line, which implies more potential problems and costs. Electrocardiogram (ECG)-based positioning of the CVC tip is of growing interest, because it allows control of the catheter position during insertion procedure. Although the ECG-based method has been considered to be safe, accurate, quick and easy to perform, radiation-free, and real-time verification, its clinical effectiveness and cost-effectiveness compared with post-procedural chest x-ray method remains to be determined. The purpose of this report is to review the evidence regarding the clinical effectiveness and cost-effectiveness of electrocardiograms versus x-rays for the guided placement of central venous catheter tips.

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