A new pressure-based device for tip navigation and tip location during central venous catheterization: A prospective clinical study on a cohort of 136 adult patients

Abstract

Introduction:

According to current guidelines, tip location of peripherally inserted central catheters (PICCs) should be verified during insertion, preferably using non-invasive methods such as intracavitary ECG (IC-ECG) or echocardiography. An interesting new option is represented by a new pressure-based device, the CatFinder System (CFS), which might be theoretically useful also for tip navigation.

Methods:

We planned a single-center, prospective, non-randomized trial on adult patients requiring PICC insertion, using simultaneously CFS and IC-ECG, with the purpose of verifying the applicability, feasibility, safety, and accuracy of CFS for intra-procedural tip location. Patients with known ECG abnormalities or cardiac diseases of any type were excluded. The ability of CFS to assess wrong directions of the catheter during insertion (tip navigation) was evaluated by comparison with ultrasound scan.

Results:

Out of 136 enrolled adult patients, CFS was found to be applicable in 131 cases (five cases were excluded because of ECG abnormalities) and feasible in 111 cases (in 20 cases, tip location by CFS could not be carried out because of technical issues). There were no complications directly or indirectly related to the CFS maneuvers. Using IC-ECG as a comparison, 87 tips placed by CFS were within 2 cm from the target, 17 were >2 cm from target. In seven cases, CFS was able to detect a wrong direction (to the ipsilateral internal jugular vein), as confirmed by ultrasound.

Conclusion:

Applicability of CFS in patients with sinus rhythm was 96.3%, feasibility was 84.7%, and safety was 100%. If compared to IC-ECG, accuracy was 83.6% (accepting an error <2 cm) and 96.1% (for an error <3 cm). Unacceptable tip positions (>3 cm) were 3.8% (the tip was too high inside the SVC). This study confirms a possible future role of CFS for intra-procedural tip location and tip navigation, though its use cannot be currently recommended.

Keywords

Tip location tip navigation central venous access device PICC intracavitary ECG ultrasound

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References

Pittiruti

Hamilton

Biffi

, et al. ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009; 28: 365–377.

Gorski

Hadaway

Hagle

, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs 2021; 44: S1–S224.

Lamperti

Biasucci

Disma

, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol 2020; 37: 344–376.

Pittiruti

Pelagatti

Pinelli

Intracavitary electrocardiography for tip location during central venous catheterization: a narrative review of 70 years of clinical studies. J Vasc Access 2021; 22: 778–785.

Greca

Iacobone

Elisei

, et al. ECHOTIP: a structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients. J Vasc Access. Epub ahead of print 8 September 2021. DOI: 10.1177/11297298211044325.

Iacobone

Elisei

Gattari

, et al. Transthoracic echocardiography as bedside technique to verify tip location of central venous catheters in patients with atrial arrhythmia. J Vasc Access 2020; 21: 861–867.

Pittiruti

Scoppettuolo

Dolcetti

, et al. Clinical use of Sherlock-3CG^® for positioning peripherally inserted central catheters. J Vasc Access 2019; 20: 356–361.

Siskin

Sansivero

Tessier

, et al. Abstract No. 325: use of the Elcam Medical catheter tip locator system (the CatFinder) to determine catheter tip location in 131 patients. Journal of vascular access and interventional radiology 2010; 21(Suppl. 2): S122–S123.

Emoli

Cappuccio

Marche

, et al. [The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC)]. Assist Inferm Ric 2014; 33: 82–89.

10.

Brescia

Pittiruti

Spencer

, et al. The SIP protocol update: eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access. Epub ahead of print 27 May 2022. DOI: 10.1177/11297298221099838.

11.

Pittiruti

Bertollo

Briglia

, et al. The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. J Vasc Access 2012; 13: 357–365.

12.

Calabrese

Montini

Arlotta

, et al. A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients. J Vasc Access 2019; 20: 516–523.

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