Reappraisal of ultrasound imaging of neonatal intravascular catheters.

Umbilical venous catheter position: evaluation by ultrasound

“…Catheter malposition may lead to severe complications, such as bleeding, perforation into the peritoneal cavity or urachus, arrhythmia, cardiac tamponade, thrombosis, pulmonary infarction or abscess, and liver damage, with fluid collections in the liver parenchyma [2,5,8]. Paraplegia and even death could be result of placement of the catheter into the left ascending lumbar vein [6,7].…”

“…The last portion of this complex course runs in the sagittal plane, therefore is not visualized properly on the AP view on standard radiograph; thus several studies have questioned the usefulness of radiograph to evaluate catheter position. Ultrasonography has been suggested as an aid to evaluation catheter placement [4][5][6][7][8][9][10].…”

“…Catheter malposition can lead to serious complications [2,[5][6][7][8]. In recent years, we have had several cases of liver fluid collections secondary to umbilical catheter malposition discovered by ultrasound in babies with altered hepatic functions.…”

Digital imaging does not improve localization of percutaneously inserted central lines in neonates

“…As the use of PIC lines plays an important role in the NICU, further techniques 26,27 to determine PIC line tip position should be evaluated. Meanwhile, it is important for clinicians to be aware of the limitations in current practice for localizing PIC line tips, including standard radiography with contrast and PACS.…”

Neonatal long lines

“…Contrast injection may under-or overestimate catheter length, because the catheter may be either partially filled or extrude a jet of contrast from the tip at the time of the x ray examination. There may be a case for the more widespread use of ultrasound 27 and intravascular ECG 28 to aid placement of CV lines. Manipulation of digitised images may also make line tip identification easier.…”