The effect of two intracavitary electrocardiogram guidance on the positioning and complications of peripherally inserted central catheters in newborns: A network meta-analysis

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BACKGROUND: Intracavitary electrocardiogram (IC-ECG) refers to the use of normal saline column or guidewire as a probe electrode to guide the electrocardiogram during central venous catheter-placement, and then determine the position of the catheter tip in real time according to the characteristic changes of the electrocardiogram P wave during the catheterization. However, there are still controversies regarding the accuracy of catheter tip positioning and the incidence of complications in guiding the placement of peripherally inserted central catheters (PICCs) in newborns using metallic guidewire IC-ECG and normal saline column IC-ECG. In this study, a network meta-analysis was used to evaluate the effects of these 2 methods on the accuracy of catheter tip positioning and the incidence of complications during neonatal PICC catheterization, providing evidence for their clinical application. METHODS: Randomized controlled trials assessing IC-ECG-guided PICC placement in newborns were collected up to May 30, 2025. Two evaluators independently screened the literature, extracted data, and assessed the risk of bias in the included studies. RevMan 5.3 and Stata14.0 software were used for statistical analysis. RESULTS: A total of twenty studies were included, involving 2566 newborns. Network meta-analysis showed that metallic guidewire IC-ECG was optimal in the accuracy of tip position and the incidence of catheter-related bloodstream infections. Normal saline column IC-ECG had the lowest incidence of complications, phlebitis, arrhythmias, and thrombosis/occlusion. CONCLUSION: Metallic guidewire IC-ECG may be better than normal saline IC-ECG in PICC catheter tip location accuracy. In terms of complications, normal saline IC-ECG may have a lower risk.

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