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

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.

Keywords

TIVAD IC-ECG catheter tip

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