Peripherally Inserted Central Catheter Placement Verification Using Electrocardiogram Technology

Purpose of the study: To improve the success of peripherally inserted central (PICC) line placement procedures by using electrocardiogram (ECG) verification technology. To increase first-time placement success rates and reduce the number of times a catheter must be repositioned before obtaining correct tip location.
Question: Does the use of ECG verification technology during peripherally inserted PICC line placement improve the inserter’s rate of success in obtaining correct first-time tip placement?
Methods: This was a retrospective comparison study conducted at a single large military medical center in Virginia, where PICCs are placed in appropriate inpatient adults. The sample size for the ECG group was determined by the number of PICC lines ordered between September 2016 and September 2017. The sample size of the usual care group was the number of PICC lines placed without the use of the ECG technology. Typically, an average of 20 PICC lines are placed per month in this facility.
Procedures: PICC line nurses received training regarding the Celerity ECG system and once trained, PICC lines were placed using this technology. All other placement procedures remained unchanged including a post-insertion chest x-ray to verify accurate placement. Data was retrospectively obtained from the PICC line tracking spreadsheet. The repositioning rates of the PICC lines placed using the ECG technology were compared with the repositioning rates of PICC lines placed without the ECG technology.
Results: There were 164 PICC lines placed during the specified time frame. ECG was used in 73 (44.5%) of the PICC lines placements and was not used in 91 (55.5%). There was no statistical significance between the repositioning rates of the ECG group compared to the usual care group (p=0.242).
Conclusions: The implementation of the ECG technology did not produce an improvement in the success rate of correct PICC line placement. However, this study did highlight the importance of systematic evaluation after any quality improvement project.