Safety and Feasibility of Electrocardiogram-Guided Tip Positioning Combined with Ultrasound-Guided Placement of Peripherally Inserted Central Catheter Performed in Severe Brain Injury Patients

To explore the safety and feasibility of using electrocardiogram (ECG)-guided tip positioning combined with ultrasound-guided placement of peripherally inserted central catheters (PICC) in patients with severe brain injury in a neurosurgery intensive care unit.

We retrospectively analyzed 400 patients who underwent PICC catheterization in a neurosurgery intensive care unit from January 2017 to January 2021. Of those, a group of 157 patients received only ultrasound-guided PICC placement. The second group (243 patients) received ECG-guided tip positioning combined with ultrasound-guided PICC placement. A logistic regression analysis was conducted on gender, arm circumference, and ECG usage based on whether the results were in place. The positioning accuracy, success rate of primary catheterization, incidence of ectopic catheters, average catheterization depth, and incidence of catheterization complications were observed.

Logistic regression analysis showed that only ECG guidance helps to achieve accurate PICC (OD, 4.541; 95CI, 2.224–9.271; p < 0.001). The correct placement rate of the PICC tip was significantly higher in ECG-guided tip positioning combined with the ultrasound guidance group (90.73%) compared to the ultrasound-only group (79.00%, P < 0.001). There was no significant difference between the two groups in terms of difficult catheter delivery and replace the punctured vessel, and the incidences of blocked blood return in the ECG-plus-ultrasound group was significantly better than the ultrasound group (9.55%) (χ² = 14.402, P < 0.001).

In patients with severe brain injury, ECG-guided tip positioning combined with ultrasound guidance in PICC catheterization can significantly increase the rate of correct tip placement without increasing the difficulty of catheterization.