Emphasizing precise tip placement in central vascular access devices is crucial for optimal PICC insertions. Methods to confirm proper placement vary based on clinician training and preferences, and institution resources. While tip confirmation via chest x-ray has historically been the “gold standard,” intra-cavitary electrocardiography (IC-ECG) has gained popularity for its effectiveness and cost-efficiency in the last decades. Tip confirmation systems (TCS), which pair magnetic tracking and ECGs, have emerged as the latest alternative approach. In this short article we discuss if there are clinical advantages using the TCS versus the standard IC-ECG.
Despite perceived advanced technology, the ongoing debate in the medical community revolves around the necessity of incorporating TCS into routine PICC line insertions. The key appeal of TCS is its real-time tracking capability, ensuring accurate catheter tip positioning. Advocates argue for enhanced patient safety through mitigated complications. However, numerous studies dispute this, suggesting that standard IC-ECGs achieve comparable or superior results without magnetic tracking. Some studies even highlight the clunkiness and real-time limitations of using the device during procedures.
Moreover, the implementation of the TCS poses substantial financial implications for healthcare institutions. The initial investment includes burdensome contracts, the purchase of the system, products designed to use with said system, and the requisite training for nursing staff. Hospitals must carefully weigh these costs against the clinical benefits of the system, considering traditional placement methods have shown commendable success rates.
In conclusion, while the TCS appears to have technological advancements in PICC line placement, the industry does not agree it’s a must-have. Technology presents clear advantages but lacks conclusive evidence to surpass the efficacy of traditional methods. Healthcare institutions must consider the costs, existing proficiency in traditional techniques, and most importantly, prioritize patient safety when deciding on the adoption of such technology in routine clinical practices.
Health Line’s Synergy CT PICC line is provided with a standard, ECG compatible tip location stylet. Our product has been on the market and used extensively with standard ECG tip location systems for almost 20 years, and is relied on as a superior, efficient, effective, and affordable option.
Gullo, G. Qanadli,S. (2022, May 6). ECG-Based Techniques to Optimize Peripherally Inserted Central Catheters: Rationale for Tip Positioning and Practical Use. National Library Of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120917/
Pittiruti M, Scoppettuolo G, Dolcetti L, Emoli A. Clinical use of Sherlock-3CG® for positioning peripherally inserted central catheters. The Journal of Vascular Access. 2019;20(4):356-361. doi:10.1177/1129729818805957
Pittiruti, M. et al. (2020, June 24) Intracavitary electrocardiography for tip location during central venous catheterization: A narrative review of 70 years of clinical studies. The Journal of Vascular Access. https://journals.sagepub.com/doi/abs/10.1177/1129729820929835
Pittiruti, M. et al. (2018, October 18) Clinical use of Sherlock-3CG® for positioning peripherally inserted central catheters. The Journal of Vascular Access. Clinical use of Sherlock-3CG® for positioning peripherally inserted central catheters – Mauro Pittiruti, Giancarlo Scoppettuolo, Laura Dolcetti, Alessandro Emoli, 2019 (sagepub.com)