Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study

  • Ai-qing Xiao
  • Jing Sun
  • Li-hui ZhuEmail author
  • Zhen-yu Liao
  • Ping Shen
  • Lin-lin Zhao
  • Jos M. Latour
Original Article


This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666–21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068–0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013–8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.

Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.

What is Known:

• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.

• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.

What is New:

• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.

• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.


Chest radiography Electrocardiogram Peripherally inserted central catheter Preterm infants Tip positioning 



Catheter-Related Blood Stream Infection


Central Venous Catheters


Intracavitary Electrocardiogram


Neonatal intensive care unit


Peripherally inserted central catheter



We thank all the parents for consenting and participating in this study. We also thank the nurses and doctors for their participation in our study.

Authors’ contributions

AqX, JS, LhZ, ZyL, PS, LlZ, JML contributed to the design of the study. LhZ secured funding for the study. AqX, ZyL, PS, LlZ contributed to the data collection; JS, JML contributed to the data analysis; JS and JML drafted the first manuscript. AqX, LhZ, ZyL, PS, LlZ provided revisions. All authors contributed to manuscript revision, read and approved the submitted version.

Funding information

This study was partly funded by the Education Department of Hunan Province (number CX2018B510) (JS), Health Commission of Hunan province (number C2019015) (AqX) and the Hunan Provincial Government through the One Hundred Talent Program (JML). The authors do not have a financial relationship with the organization that sponsored the study.

Compliance with ethical standards

All procedures performed in the studies were in accordance with the ethical standards of Ethics Committee of Hunan Children’s Hospital, Xiangtan Central Hospital and the Declaration of Helsinki.

Conflict of interest

All authors declare no competing interest and no financial conflicts.

Ethical approval

The protocol was approved by the Ethics Committee of Hunan Children’s Hospital (HCHLL-2018-06). Parents were informed that their decision to refuse or withdraw from the study would not impact on the care of their infant.

Informed consent

Written informed consent was obtained from all parents included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Neonatal MedicineHunan Children’s HospitalChangshaChina
  2. 2.Nursing schoolHunan University of Chinese MedicineChangshaChina
  3. 3.Nursing DepartmentHunan Children’s HospitalChangshaChina
  4. 4.Division of Neonatal MedicineXiangtan Central HospitalXiangtanChina
  5. 5.School of Nursing and Midwifery, Faculty of Health and Human SciencesUniversity of PlymouthPlymouthUK

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