Point-of-Care Ultrasound-Guided Protocol to Confirm Central Venous Catheter Placement in Pediatric Patients Undergoing Cardiothoracic Surgery: A Prospective Feasibility Study

Abstract

Background: Central venous catheters (CVC) are commonly required for pediatric congenital cardiac surgeries. The current standard for verification of CVC positioning following perioperative insertion is postsurgical radiography. However, incorrect positioning may induce serious complications, including pleural and pericardial effusion, arrhythmias, valvular damage, or incorrect drug release, and point of care diagnostic may prevent these serious consequences. Furthermore, pediatric patients with congenital heart disease receive various radiological procedures. Although relatively low, radiation exposure accumulates over the lifetime, potentially reaching high carcinogenic values in pediatric patients with chronic disease, and therefore needs to be limited. We hypothesized that correct CVC positioning in pediatric patients can be performed quickly and safely by point-of-care ultrasound diagnostic. Methods: We evaluated a point-of-care ultrasound protocol, consistent with the combination of parasternal craniocaudal, parasternal transversal, suprasternal notch, and subcostal probe positions, to verify tip positioning in any of the evaluated views at initial CVC placement in pediatric patients undergoing cardiothoracic surgery for congenital heart disease. Results: Using the combination of the four views, the CVC tip could be identified and positioned in 25 of 27 examinations (92.6%). Correct positioning was confirmed via chest X-ray after the surgery in all cases. Conclusions: In pediatric cardiac patients, point-of-care ultrasound diagnostic may be effective to confirm CVC positioning following initial placement and to reduce radiation exposure.

Lower Patient Height and Weight Are Predisposing Factors for Complex Radial Arterial Catheterization

“…The resulting multiple attempts lead to delays in procedural processes and may induce secondary complications such as hematoma or temporary—or even permanent—vascular occlusion with subsequent distal necroses [ 1 , 2 , 8 , 9 ]. Ultrasound guidance for vascular access and regional anesthesia allows for direct visualization of targeted vessels and nerval structures and the puncture process and can provide confirmation of the correct guidewire and catheter positioning, and is therefore established in anesthesia and intensive care medicine and recommended in recent guidelines [ 10 , 11 , 12 , 13 ]. However, in contrast to venous access and nerve blockade, radial artery cannulation is still commonly performed via palpation, and sonography is only used when multiple attempts have failed.…”

Ultrasonic Measurement of the Narrowest Transverse Diameter of Subglottic Airway in Children Undergoing Elective Tracheal Intubation under General Anesthesia

“…It provides a new idea and method for selecting the best type of ETT for children. Baehner et al (2021) [13] mentioned in their study that the transverse diameter of the trachea in the strictest subglottic part of children could be individually measured by ultrasound technology. Ponde et al (2021) [14] mentioned that ultrasonic measurement technology can be utilized for guiding the selection of ETT type in children with TI clinically.…”

Central venous catheter tip positioning using ultrasound in pediatric patients—A prospective observational study

“…In contrast, the advantage of ultrasound is that it can provide the desired information immediately after catheter insertion. Controlling the catheter position solely with ultrasound has not yet been established in routine clinical practice, even though individual studies have shown that it is practicable with a good success rate 2–5 . Minimizing radiation dose is desirable, especially in young people.…”

“…The 8-3 MHz probe was used most frequently. While maintaining the supine position, the superior vena cava vein (SVC) and right atrium (RA) were visualized using ultrasound from four different positions (Figure 1A), three of which were described by Baehner et al 2 in a previous feasibility study, as follows:…”