ECG or X-ray as the 'gold standard' for establishing PICC-tip location?

Recently there has been an increase in evidence that the tip position of a peripherally inserted central catheter (PICC) needs to be accurately placed in the lower third of the superior vena cava at the junction with the right atrium in order to minimise potential complications ( Royal College of Nursing, 2010 ; Infusion Nurses Society, 2011 ). The current 'gold standard' practice of performing a chest X-ray post-insertion of PICC can be fraught with complications with regard to accurately placing the PICC in this position. The purpose of this evaluation is to discuss how using an electrocardiogram-guided PICC placement system may be a preferable method with which to accurately measure the exact position of the PICC within the venous system.