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

Abstract

Objective Central catheters (CCs) are routinely used in the neonatal intensive care unit (NICU). Ultrasonography (US) has been advocated as a procedural adjunct for CC placement to better localize catheter tip position (CTP), minimize radiation exposure, and decrease procedural burden. This review evaluates the clinical benefit, practical considerations for implementation, and limitations of US for CC placement in the NICU. Study Design A literature search was conducted using the Pubmed and Ovid databases with search terms regarding the ultrasound modality relating to CCs in infants and neonates. Results Five studies regarding US-guided CC insertions and seven studies describing postinsertion US were determined pertinent to this review's objective and discussed. Conclusions At this time, the literature seems insufficient to recommend US as a replacement for radiography for CTP confirmation; however, US-guidance during insertion followed by radiographic verification can decrease line manipulations and repeat radiographs. Postinsertion assessments by US can better determine the CTP and guide repositioning decisions, reducing the likelihood of malposition and potential complications, and may be more practical for many NICUs. However, it is unclear how much training and experience is necessary to deem an individual competent for reliable and clinically beneficial bedside US evaluations.

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

“…POCUS is helpful to locate catheter tip position in neonates and children-strong agreement (quality of evidence C). A trial and two observational studies in the paediatric and neonatal population have suggested that US may decrease radiation and number of line manipulations by confirming PICC tip position after placement [121][122][123] and could be considered a complement to conventional radiography [124]. D. Recommendations for use of cerebral POCUS 1.…”

Use of clinician‐performed ultrasound in the assessment of safe umbilical venous catheter tip placement

“…Since the first reports of the use of ultrasound in confirming UVC placement, 9,10 studies have suggested that ultrasound confirmation of the safe placement of UVCs should be considered standard. [2][3][4][5][11][12][13][14][15][16][17] Ultrasound enables precise determination of the catheter tip in relation to the portal venous system, IVC and heart, thereby minimising complications related to malposition within the liver or heart, as well as avoiding or minimising exposure to X-ray radiation. Our results demonstrate that CPU for line localisation is clinically useful, with CPU informing further management of the line in 41% and identifying unsafe placement despite adequate X-ray position in 14% (15 cases).…”

Rapid Assessment of the Neonate With Sonography (RANS) Scan

“…Point‐of‐care sonography at the bedside represents a valuable yet underutilized diagnostic tool for clinicians and care teams in the NICU. There is growing evidence of the utility of point‐of‐care sonography to reduce procedure time, and to diagnose and begin intervention in acute processes in pediatric emergency medicine (PEM), pediatric critical care medicine, and neonatal‐perinatal medicine . The utilization rate and creation of a definitive curriculum, however, has been more pronounced in PEM.…”

“…There is growing evidence of the utility of point-of-care sonography to reduce procedure time, and to diagnose and begin intervention in acute processes in pediatric emergency medicine (PEM), pediatric critical care medicine, and neonatal-perinatal medicine. 4,[11][12][13][14][15] The (1), which appear as horizontal, regularly spaced, hyperechoic lines due to reverberations of the pleura. C, Sonography of the left lung showing the sliding lung sign with a shimmering effect (3).…”