Safety and accuracy of intracardiac electrocardiography-guided catheter tip positioning in totally implantable venous access device placement compared to X-ray guidance.

IF 1.6 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Access Pub Date : 2025-05-03 DOI:10.1177/11297298251336518

Jianting Zhao, Xiaofang Wu, Xiujuan Wu, Zhigang Zhu, Dongliu Miao, Qiong Wu, Yiqi Jin

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引用次数: 0

Abstract

Purpose: To assess the accuracy and safety of intracardiac electrocardiography (IC-ECG) in positioning catheter tips for Totally Implantable Venous Access Device (TIVAD) placement.

Methods: This study conducts a retrospective analysis of patient data collected from The Affiliated Suzhou Hospital of Nanjing Medical University. Patients were categorized into two groups based on the method used for catheter tip positioning: the IC-ECG group and the X-ray group. Propensity Score Matching (PSM) is employed to balance the baseline characteristics of the two groups in a 1:2 ratio. The primary outcomes of interest are the ideal position rate of the TIVAD tip and the incidence of complications. Additionally, multivariable logistic regression analysis will be utilized to identify risk factors associated with complications. The area under the ROC curve (AUC) will be calculated to evaluate the diagnostic performance of the detection methods.

Results: During the period from January 2023 to June 2024, a total of 493 adult oncology patients received TIVAD. After applying PSM, 465 patients were included in the retrospective analysis, comprising 221 males (47.5%) and 244 females (52.5%), with a mean age of 62.6 years. The ideal position rates for the catheter tips were 150 cases (96.8%) in IC-ECG group and 301 cases (97.1%) in X-ray group (p = 0.834). The distance from the catheter tip to the carina was measured at 1.60 ± 0.356 and 1.41 ± 0.34 vertebral body units, respectively (p < 0.01). The overall complication rates were comparable between the two groups. Multivariate logistic regression analysis indicated that BMI is an independent risk factor for TIVAD-related complications (OR = 0.437, 95% CI: 0.319-0.563, p < 0.001). The ROC curve analysis revealed that the area under the curve (AUC) for BMI was 0.926 (95% CI: 0.886-0.926, p < 0.001).

Conclusion: Intracardiac electrocardiography (IC-ECG)-guided catheter tip positioning for TIVAD placement has demonstrated accuracy, feasibility, and safety. Given its potential to reduce radiation exposure, improve safety, and offer cost-effectiveness, IC-ECG presents a promising method for catheter tip positioning in TIVAD procedures. Based on these advantages, IC-ECG could be considered a preferable method in clinical practice.

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与x线引导相比，心内心电图引导导管尖端定位在全植入式静脉通路装置放置中的安全性和准确性。

目的：评价全植入式静脉通路装置（TIVAD）置管时心内心电图（IC-ECG）定位导管尖端的准确性和安全性。方法：对南京医科大学附属苏州医院的患者资料进行回顾性分析。根据导管尖端定位方法将患者分为两组：IC-ECG组和x线组。采用倾向得分匹配（PSM），以1:2的比例平衡两组的基线特征。主要关注的结果是TIVAD尖端的理想位置率和并发症的发生率。此外，多变量逻辑回归分析将被用于识别与并发症相关的危险因素。计算ROC曲线下面积（AUC）以评估检测方法的诊断性能。结果：2023年1月至2024年6月，共有493例成人肿瘤患者接受了TIVAD治疗。应用PSM后纳入465例患者进行回顾性分析，其中男性221例（47.5%），女性244例（52.5%），平均年龄62.6岁。IC-ECG组150例（96.8%），x线组301例（97.1%）（p = 0.834）。测量导管尖端到椎体突的距离分别为1.60±0.356和1.41±0.34个椎体单位（p p p）。结论：在心电图（IC-ECG）引导下，导管尖端定位用于植入TIVAD具有准确性、可行性和安全性。鉴于IC-ECG具有减少辐射暴露、提高安全性和提供成本效益的潜力，它是TIVAD手术中导管尖端定位的一种有前景的方法。基于这些优点，IC-ECG可被认为是临床较好的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Access 医学-外周血管病

CiteScore

3.40

自引率

31.60%

发文量

181

审稿时长

6-12 weeks

期刊介绍： The Journal of Vascular Access (JVA) is issued six times per year; it considers the publication of original manuscripts dealing with clinical and laboratory investigations in the fast growing field of vascular access. In addition reviews, case reports and clinical trials are welcome, as well as papers dedicated to more practical aspects covering new devices and techniques. All contributions, coming from all over the world, undergo the peer-review process. The Journal of Vascular Access is divided into independent sections, each led by Editors of the highest scientific level: • Dialysis • Oncology • Interventional radiology • Nutrition • Nursing • Intensive care Correspondence related to published papers is also welcome.