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"Chest radiography and malpositions can be eliminated with the use of technology that includes Doppler, echocardiography (ECG), and an algorithm" Girgenti and Donnellan (2014).

Abstract:

It can be difficult to get the tip of a central vascular access device to the targeted area of the caval-atrial junction accurately and precisely when placing a device at the bedside. Tip placement outside this precise location can lead to complications and poor patient outcomes. Malpositions increase patients’ radiation exposure, increase costs, and delay treatment. The current standard of using chest radiography to check tip placement has demonstrated discrepancies and is subject to interpretation differences between radiologists. Chest radiography and malpositions can be eliminated with the use of technology that includes Doppler, echocardiography (ECG), and an algorithm. This technology can reduce the cost of labor and supplies in addition to allowing the use of a central vascular access device immediately after placement.

Reference:

Girgenti, C. and Donnellan, E. (2014) Successfully Eliminating Chest Radiography by Replacing It With Dual Vector Technology and an Algorithm for PICC Placement. The Journal of the Association for Vascular Access. 19(2), p.71-74.