Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study

Rubortone, Serena Antonia; Costa, Simonetta; Perri, Alessandro; D’Andrea, Vito; Vento, Giovanni; Barone, Giovanni

doi:10.1186/s13052-021-01014-7

Cited by 26 publications

(37 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent pre/post-intervention study by Rubortone et al confirmed a reduction in the number of X-rays requested for UVC position confirmation in the postintervention phase when US was used (92.3% vs. 32.1%; p < 0.0001). However, a potential bias was the choice of the confirmatory method (X-ray or US) which was left to the attending neonatologist and was not standardised [22]. Our findings confirm these trends, in a bigger sample size.…”

Section: Goodsupporting

confidence: 80%

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

et al. 2022

View full text Add to dashboard Cite

Objective of the study was to compare number of X-rays performed for neonatal central line tip positioning when real-time US is used compared to X-ray only, and to assess consequences on position accuracy, irradiation and cost. Retrospective monocentric cohort study conducted at Evelina London Children's Hospital Neonatal Unit over 6 months. Study was conducted during implementation of US for line tip localisation with formulation of US protocol. Tip position on X-ray was reviewed by one neonatologist and one radiologist and inter-rater agreement calculated. Criteria for good, satisfactory or inadequate position of the tip were defined. Estimated effective radiation dose and cost for each X-ray was determined. Two hundred seventy-four lines were inserted (nPICC, UVC, UAC). Eighty-three lines were scanned with US (US group); 191 lines were not (no-US group). Number of X-rays performed was significantly lower in the US group: 1.19 vs. 1.5 (p 0.001), related to a significantly lower percentage of lines requiring multiple X-rays (38.7% no-US group vs. 19.9% US group; p 0.004). Accuracy was higher in US group with more lines at cavoatrial junction (p 0.05) and was significantly increased with US use for lines inserted from lower limbs (22.9% and 76.2%, p 0.001). Inter-rater agreement was strong (k > 0.8). US group received lower mean radiation dose (p < 0.001) and cost related to X-ray was significantly reduced (p 0.001).Conclusion: Real-time US use for line tip positioning in the NICU significantly decreased the number of X-rays performed and was associated with better-positioned lines, decreased irradiation and cost. What is Known:• The use of point-of-care ultrasound (PoCUS) by critical care providers in neonatology has increased in recent years. International guidelines advocate for the use of PoCUS as valid guidance to practical procedures in neonatology. • Central catheters (umbilical catheters and neonatal peripherally inserted central catheters) are among the most commonly used devices to support NICU patients. Proper positioning is crucial to avoid complications and PoCUS has high sensitivity and specificity in accurately determining line tip position. The current standard practice for line tip position confirmation in neonatology is still conventional radiography despite multiple evidenc suggest significant inaccuracy of X-ray compared to ultrasound. What is New: • PoCUS implementation for line tip positioning leads to a significant decrease in the number of X-rays performed, in radiation effective dose and costs. PoCUS evaluation of central catheters significantly increases the accuracy of the final line tip position with more lines at the cavoatrial junction. • Training is fundamental for univocal interpretation of ultrasound images and an effective learning strategy is being proposed.

show abstract

Section: Goodsupporting

confidence: 80%

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A recent pre/post intervention study demonstrated the feasibility of targeted training on the use of POCUS for UVC placement in NICU among neonatal medical staff. The technique was easily teachable, increased the number of UVCs correctly positioned, and reduced the number of line manipulations and chest X-rays ( 48 ).…”

Section: Insertion Of the Uvc Including New Technologiesmentioning

confidence: 99%

“…The inward migration was explained by cord stump contraction over time together with an increase in lung volume (due to the increase in the functional residual capacity, e.g., following surfactant administration), the outward migration instead was likely to result from gradual distension of the abdomen as the bowel filled with gas ( 58 ). About half the infants included in the studies experienced migration, mainly inward within 24–48 h from the catheter insertion ( 48 , 59 , 60 ).…”

Section: Migrationmentioning

confidence: 99%

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

et al. 2022

Self Cite

View full text Add to dashboard Cite

The umbilical venous catheter (UVC) is one of the most commonly used central lines in neonates. It can be easily inserted soon after birth providing stable intravenous access in infants requiring advanced resuscitation in the delivery room or needing medications, fluids, and parenteral nutrition during the 1st days of life. Resident training is crucial for UVC placement. The use of simulators allows trainees to gain practical experience and confidence in performing the procedure without risks for patients. UVCs are easy to insert, however when the procedure is performed without the use of ultrasound, there is a quite high risk, up to 40%, of non-central position. Ultrasound-guided UVC tip location is a simple and learnable technique and therefore should be widespread among all physicians. The feasibility of targeted training on the use of point-of-care ultrasound (POCUS) for UVC placement in the neonatal intensive care unit (NICU) among neonatal medical staff has been demonstrated. Conversely, UVC-related complications are very common and can sometimes be life-threatening. Despite UVCs being used by neonatologists for over 60 years, there are still no standard guidelines for assessment or monitoring of tip location, securement, management, or dwell time. This review article is an overview of the current knowledge and evidence available in the literature about UVCs. Our aim is to provide precise and updated recommendations on the use of this central line.

show abstract

“…POCUS can also be used to confirm catheter tip location in venous vascular cannulation. Ultrasound confirmed catheter tip location has been deemed to be safe and effective in midline catheters in adults, umbilical venous catheter and PICC lines in neonates, and to have good agreement with chest x-ray in central venous catheters in pediatric patients (26)(27)(28)(29).…”

Section: Vascular Cannulationmentioning

confidence: 94%

Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

2022

View full text Add to dashboard Cite

Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.

show abstract

Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study

Cited by 26 publications

References 29 publications

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

Contact Info

Product

Resources

About