The intracavitary ECG method for tip location of ultrasound-guided centrally inserted central catheter in neonates

Abstract

Background: The correct position of the tip of a central venous access device is important in all patients, and especially in neonates. The traditional method of tip location (approximated intra-procedural length estimation + post procedural chest X-ray) is currently considered inaccurate and not cost-effective by most recent guidelines, which recommend the adoption of tip location by intracavitary electrocardiography (IC-ECG) whenever possible. Methods: This study prospectively investigated the applicability, the feasibility, the accuracy, and the safety IC-ECG for tip location in neonates requiring insertion of ultrasound-guided centrally inserted central venous catheters (CICCs) with caliber 3Fr or more. All catheter tip locations were verified using simultaneously both IC-ECG and ultrasound-based tip location, using the Neo-ECHOTIP protocol. Results: A total of 105 neonates were enrolled. The applicability of IC-ECG was 100% since a P wave was evident on the surface ECG of all neonates recruited for the study. The feasibility was also 100% since an increase of the P-wave was detected in all cases. The accuracy was also 100%, since a perfect match between IC-ECG based tip location and ultrasound-based tip location was found. There were no adverse events directly or indirectly related to the IC-ECG technique; no arrhythmias occurred. Conclusions: When applied to ultrasound guided CICCs, tip location by IC-ECG is applicable and feasible in neonates, and it is safe and accurate.

Chest-to-arm tunneling technique for central venous access devices in neonates

“…16 We had chosen ultrasound-based tip location because is particularly easy in neonates, but the intracavitary ECG technique is also an excellent option for tip location in neonates. 17 In all patients, the tip position of CICC was the upper third of the RA. The exit site and the skin incisions were sealed with cyanoacrylate glue in all patients.…”

“…Ultrasound-guided CICC implantation in the newborn is recommended by international guidelines, 1,19,20 and ultrasound control of the tip position according to the most up-to-date guidelines does not require chest radiographs—which is far less accurate- avoiding ionizing radiation to the newborn. 17,19,20…”

Tecnologias para manutenção do Cateter Central de Inserção Periférica em neonatos: revisão integrativa

“…46 O ECG se mostra com uma tecnologia adequada para a colocação guiada do PICC e para a verificação do posicionamento da ponta do cateter, com precisão de 100%. 62 O procedimento tem como vantagens: a precisão de ser em tempo real, evitar a radiação, menor tempo para inserção, ser um procedimento simples que requer a habilidade do profissional.…”

Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients

“…Several clinical studies have demonstrated that IC-ECG is more accurate than radiological methods when compared to the TEE [13][14][15] ; the method is also easy and inexpensive, and it can be applied in adults, 6 in children 16 and in neonates. 17 The other main intra-procedural method for tip location is TTE: ultrasound-based tip location is based on the ultrasound visualization of the right atrium using a convex or a sectorial probe, adopting different acoustic windows (the subxiphoid longitudinal view, the subxiphoid bi-caval view, and the apical view); this method of tip location has been standardized in adults, 7 in children 18 and in neonates. 19 Tip location of FICCs still remains a matter of debate.…”