The electrocardiographic method for positioning the tip of central venous access device

Background: The electrocardiogram-based insertion method is non-radiative, allowing real-time positioning verification and reducing the need for postoperative repositioning. Methods: Relevant databases published from January 1990 to January 2019 in PubMed, Web of Knowledge, Medline and Ovid’s database were searched, comparing the effectiveness of electrocardiogram-guided catheter tip positioning (electrocardiogram-guided group) and the landmarks-guided insertion plus chest X-ray confirmation (landmarks-guided group). The primary outcome was accurate catheter tip placement and the secondary outcomes were complications. Results: A total of 13 studies were finally included with a total of 4988 patients, of whom 2789 cases were in the electrocardiogram-guided group and 2199 cases received landmarks-guided insertion plus chest X-ray. Compared with the landmarks-guided group, our meta-analysis showed that the electrocardiogram-guided group had a higher success rate of tip placement (odds ratio = 0.21, 95% confidence interval = 0.14–0.34, p < 0.00001) and fewer total complications (odds ratio = 0.10, 95% confidence interval = 0.04–0.23, p < 0.000001). Conclusion: Based on our findings, electrocardiogram-guided tip placement for central venous access device was more accurate and safer than landmarks-guided positioning, which may be considered as an alternative method to the standard radiological control of tip placement.