From accuracy to applicability: A consensus-aligned narrative review on bedside ECG- and ultrasound-based PICC tip positioning

Abstract

Peripherally inserted central catheter (PICC) tip positioning is a technically mature field characterized by heterogeneous evidence. International consensus guidelines consistently recommend bedside intracavitary electrocardiography (IC-ECG) and ultrasound-based strategies as first-line methods, with fluoroscopy reserved for specific indications. This narrative review clarifies the conceptual distinction between tip navigation (guiding catheter advancement to prevent misdirection) and tip location (confirming final tip position)-two fundamentally different clinical problems that have been conflated in much of the literature. We explain how current consensus recommendations, including the 2025 Italian expert consensus on tip location methods, integrate multiple dimensions beyond technical accuracy: accuracy sufficiency, radiation safety, true bedside feasibility, system scalability, and cost-effectiveness. Implementation considerations for different clinical settings and the role of combined techniques are discussed. The transition from fluoroscopy-based confirmation to bedside physiological and imaging guidance reflects not a compromise in accuracy, but a redefinition of what "accuracy" means in real-world vascular access systems.

The authors' abstract, as published at the source. The Journal of Vascular Access, 2026 · DOI ↗