Intracavitary EKG: A non-inferiority, prospective observational study comparing two methods, three devices

Abstract

Introduction: Accurate placement of central venous catheter tips is crucial for preventing complications, such as arrhythmias and vascular injuries. Intracavitary electrocardiography (I-EKG) has emerged as a reliable alternative to chest X-rays for catheter tip positioning, offering real-time results without radiation exposure. This study evaluates the quality of I-EKG tracings using two methods: the saline column method with the alligator clip and spindle system (Deltamed, Viadana, Italy) and the pure saline column method using the "red" connector cable (Vygon Card^® Vygon, Ecouen, France) and the "yellow" connector cable (Fast Tip^® ATL Milano, Assago, Italy).

Methods: Twelve patients undergoing a peripherally inserted central catheter (PICC) placement were enrolled in this prospective study at Luigi Sacco Hospital, Milan. I-EKG tracings were recorded using all three devices, yielding a total of 36 tracings. Objective measurements of P, QR, and RS wave amplitudes were taken over five heartbeats per tracing, while twelve experienced operators performed subjective evaluations using a 5-point scale. Statistical analyses compared the three techniques.

Results: There were no significant differences in tracing quality among the methods. Objective analyses of wave amplitude ratios confirmed equivalent performance across approaches. Subjective evaluations yielded comparable scores for the "alligator-spindle," "red," and "yellow" connector techniques, with no statistically significant variation.

Conclusions: With the limits of the small sample size, the pure saline column methods ("red" and "yellow" connectors) present similar EKG trace quality while offering procedural simplicity and enhanced safety. By eliminating the need for a spindle, these may reduce the risk of arrhythmia and avoid possible effects of guidewire contamination. These findings support the broader adoption of pure saline column techniques to optimize catheter placement procedures.

Keywords: catheter tip location; centrally inserted central catheters; intracavitary electrocardiography; peripherally inserted central catheters; saline column method; vascular access devices.