Sonography-guided positioning of intravenous long lines in neonates

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

“…US examinations appear to be well tolerated even by preterm infants. 4,14,16 Significant reductions in total procedure time, number of line manipulations, and number of XRs have been observed, with no significant complications reported. [14][15][16] All studies reviewed involved an extra individual to operate the US in addition to the catheter insertion practitioner.…”

“…4,14,16 Significant reductions in total procedure time, number of line manipulations, and number of XRs have been observed, with no significant complications reported. [14][15][16] All studies reviewed involved an extra individual to operate the US in addition to the catheter insertion practitioner. It would seem reasonable that the insertion practitioner can use a sheathed ultrasound probe within the sterile field, but the technical difficulties, affect on procedure time, and potential complications of a single-practitioner endeavor have not been reported.…”

“…Almost all the studies reviewed defined optimal CTP for venous catheters to be in the vena cava or vena cava-RA junction, and not within the RA. 6,[13][14][15][16]18,19 Standard XRs are routinely done after CC insertion and is the standard of care to verify appropriate CTP. In a recent national survey of PICC practices in level III NICUs in the United States, 82% of respondents routinely obtain an XR on initial insertion, and almost 80% routinely obtain additional films after any repositioning of the catheter.…”

“…5,18,19 Catheter tips passing into the superior vena cava or pulmonary artery or brachiocephalic vessels, in the shoulder, below or within the liver, or looped in the abdomen may pose localizing challenges. 3,4,16,19 Hyperinflated lungs, pneumothorax, and gaseous abdomens can also obscure CTP determination. 7 Though some authors advocate that direct visualization of the CTP by US may eliminate the need for XRs, all the studies reviewed had confirmatory XRs for final-line placement.…”

“…Brissaud et al from France also prospectively evaluated RTUS guidance by echocardiography-trained pediatric intensivists during 36 UE PICC insertions. 16 All patients received XR confirmation after RTUS guidance that was considered the "gold standard" and directed repositioning decisions. The CTP was in proper position in only 62% of cases with RTUS guidance in comparison to XR, and 25% of lines were repositioned.…”