Prevention of catheter tip malposition with an ultrasound-guided finger-pressure method to block the internal jugular vein during PICC placement: a meta-analysis

Introduction
Peripherally inserted central catheters (PICC) are a type of deep venipuncture, for which the catheter tip malposition rate is high.

Aim
To examine the feasibility of preventing catheter tip malposition during PICC placement using an ultrasound-guided finger-pressure method to block the internal jugular vein.

Material and methods
We conducted a double-blinded randomized controlled trial (RCT) at a tertiary public hospital in Hubei province, China. A total of 600 patients were recruited and randomly allocated to the ultrasound-guided finger compression method (UGFCM) and traditional partial head method (TPHM) group (n = 300/group). Incidence of catheter tip malposition was assessed as the primary outcome of the study. A systematic literature review and meta-analysis was performed. We searched MEDLINE, EMBASE, Cochrane Library, China-National Knowledge Infrastructure, and Chinese Biomedicine Database and performed publication bias and sensitivity analyses on 10 extracted studies.

Results
There were no significant differences in baseline demographic and clinical characteristics between the two groups (p > 0.05). Overall incidence of catheter tip malposition was significantly lower in the UGFCM and TPHM group (1.67% vs. 10.3%) and particularly the incidence of malposition in the internal jugular vein (1% vs. 9%). In the meta-analysis of 10 eligible studies, with 1263 cases using the UGFCM method while 1261 adopted the TPHM method, the results showed that the incidence of catheter tip malposition was significantly lower in the group using the UGFCM method (OR = 0.17, 95% CI: 0.11–0.27, p < 0.01), which is in line with the results of our RCT study.

Conclusions
This study may add valuable evidence on adopting the finger-pressure method for blocking neck veins to reduce the incidence of catheter tip malposition, particularly in the internal jugular vein.