Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants

Tauzin, Laurent; Sigur, N.; Joubert, C.; Parra, Johanna; Hassid, Sophie; Moulies, Marie-Eve

doi:10.1111/apa.12245

Cited by 38 publications

(53 citation statements)

References 16 publications

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“…However, radiography has not been able to do this properly (16,17). Results of previous studies have indicated that ultrasound can minimize the potential side effects of improper catheter placement and reduce the need for radiography reassessment (18,19), which was confirmed in the present study.…”

Section: Discussionsupporting

confidence: 69%

Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

et al. 2020

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Background: Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography. Objectives: We compared the effectiveness of sonography with radiography for confirmation of the line tip placement. Methods: This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests. Results: A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%. Conclusions: Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning.

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Section: Discussionsupporting

confidence: 69%

Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

et al. 2020

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“…23 However, XRs are unreliable in determining exact CTP and several studies strongly suggest that RTUS instead should be considered the "gold standard" to confirm correct CTP in neonates. 4,5,8,12,13 The limitations and technical difficulties of US and RTUS scanning likely prevent US from supplanting XR as the standard of care for line verification at the current time. Even when done by trained radiologists and cardiologists, the ability to detect the CTP by US ranges from 90 to 100% compared with essentially 100% by XR.…”

Section: Discussionmentioning

confidence: 99%

“…7,18 Multiple authors advocate that RTUS done by neonatologists can minimize potential complications from line malposition and reduce XR assessments. 5,8,15,16,20 Jain et al described clinical benefit with targeted neonatal echocardiography by intensivists immediately after insertion for better determination of CTP. 6 Three studies, two of which originate from the same institution, describe bedside RTUS-guided insertions by neonatologists with varying degrees of success.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasonography for Central Catheter Placement in the Neonatal Intensive Care Unit—A Review of Utility and Practicality

Nguyen

2015

Amer J Perinatol

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Objective Central catheters (CCs) are routinely used in the neonatal intensive care unit (NICU). Ultrasonography (US) has been advocated as a procedural adjunct for CC placement to better localize catheter tip position (CTP), minimize radiation exposure, and decrease procedural burden. This review evaluates the clinical benefit, practical considerations for implementation, and limitations of US for CC placement in the NICU. Study Design A literature search was conducted using the Pubmed and Ovid databases with search terms regarding the ultrasound modality relating to CCs in infants and neonates. Results Five studies regarding US-guided CC insertions and seven studies describing postinsertion US were determined pertinent to this review's objective and discussed. Conclusions At this time, the literature seems insufficient to recommend US as a replacement for radiography for CTP confirmation; however, US-guidance during insertion followed by radiographic verification can decrease line manipulations and repeat radiographs. Postinsertion assessments by US can better determine the CTP and guide repositioning decisions, reducing the likelihood of malposition and potential complications, and may be more practical for many NICUs. However, it is unclear how much training and experience is necessary to deem an individual competent for reliable and clinically beneficial bedside US evaluations.

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“…The most common, plain radiography is plagued with concerns about poor intra- and inter-observer reliability[ 2 ]. Other modalities, e.g ., echocardiography[ 3 ] and CT[ 4 ] might be more reliable but are not readily available in most units. Use of contrast, an injectable solution that can be used to improve radio-opacity of the longline by injecting into the longline in sufficient volume to fill the connecting device and catheter, can help with recognition of unusual patterns of contrast medium dispersal and lead to easier identification of catheter malposition when combined with radiographs[ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Confirming longline position in neonates - Survey of practice in England and Wales

Arunoday¹,

Zipitis²

2017

WJCP

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AIMTo establish how neonatal units in England and Wales currently confirm longline tip position, immediately after insertion of a longline.METHODSWe conducted a telephone survey of 170 neonatal units (37 special care baby units, 81 local neonatal units and 52 neonatal intensive care units) across England and Wales over the period from January to May 2016. Data was collected on specifically designed proformas. We gathered information on the following: Unit Level designation; whether the unit used longlines and specific type used? Modality used to confirm longline tip position? Whether guide wires were routinely removed and contrast injected to determine longline position? The responders were primarily senior nurses.RESULTSWe had 100% response rate. Out of the total neonatal units surveyed (170) in England and Wales, 141 units (83%) used longlines. Fifty-five out of 81 local neonatal units (68%) using longlines, used ones that came with guide wires; a similar percentage of neonatal intensive care units, i.e., 31 out of 52 units (60%) did the same. All of those units used radiography, plain X-rays, to establish longline tip position. Out of 55 local neonatal units using longlines with guide wires, 42 (76%) were not removing wire to use contrast while this figure was 58% (18 out of 31 units) for neonatal intensive care units. Overall, only 49 out of 141 units (35%) of the units using longlines were using contrast. However it was interesting to note that use of contrast increased as one moved from special care baby units (25%, 2 out of 8 units) to local neonatal units (28%, 23 out of 81 units) and neonatal intensive care units level (46%, 24 out of 52 units) designation.CONCLUSIONNeonatal units in England and Wales are overwhelmingly relying on plain radiographs to assess longline tip position immediately after insertion. Despite evidence of its usefulness, and in the absence of perhaps more accurate methods of assessing longline tip position in a reliable and consistent way, e.g., ultrasonography, contrast is only used in a third of units.

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Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants

Abstract: This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.

Cited by 38 publications

References 16 publications

Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

Ultrasonography for Central Catheter Placement in the Neonatal Intensive Care Unit—A Review of Utility and Practicality

Confirming longline position in neonates - Survey of practice in England and Wales

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