Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

Abstract

Background: Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography. Objectives: We compared the effectiveness of sonography with radiography for confirmation of the line tip placement. Methods: This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests. Results: A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%. Conclusions: Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning.

Diagnostic accuracy of ultrasound for localising peripherally inserted central catheter tips in infants in the neonatal intensive care unit: a systematic review and meta-analysis

“…The reference standard in six studies was solely chest radiography. In two studies the reference standard was both supine chest and abdominal radiography [ 36 , 37 ].…”

“…Four studies documented that the reference test was reported incorrectly. These erroneous radiographic reports were ultimately corrected following the US examination, which demonstrated a more accurate tip position [ 36 , 38 – 40 ]. Radiographic misinterpretations in these four studies were a mixture of false reports of malposition and false reports of optimum position.…”

Práticas do enfermeiro no cateterismo epicutâneo guiado por ultrassonografia em neonatos: scoping review

“…A amostra evidenciou que publicações com a temática abordada são em pequeno número. Neste estudo, dezessete publicações foram incluídas para revisão, sendo doze (70,6%) da PubMed (BARONE et al, 2022;BAYOUMI et al, 2022;FRIDOLFSSON, 2022;GRASSO et al, 2022;ROSSI et al, 2022;TU et al, 2021;SUELL et al, 2020;MOTZ et al, 2019a;MOTZ et al, 2019b;JOHNSON et al, 2016;NGUYEN, 2016;ABDEYAZDAN et al,2014) e dois (11,7%) da EMBASE (CASTRO et al, 2014;KADIVAR et al, 2020). LILACS (VILAR et al,2020), WOS (SINGH et al, 2020), BDTD (NEGRI, 2019) contribuíram com um (5,9%) estudo cada.…”

“…produções (BARONE et al, 2022;BAYOUMI et al, 2022;FRIDOLFSSON, 2022;GRASSO et al, 2022;ROSSI et al, 2022;TU et al, 2021;KADIVAR et al, 2020;SINGH et al, 2020;SUELL et al, 2020;VILAR et al,2020;MOTZ et al, 2019a;MOTZ et al, 2019b;NEGRI, 2019). O ano de 2016 se destacou com duas (11,8%) publicações (JOHNSON et al, 2016;NGUYEN, 2016), seguido de 2014, com duas (11,8%) (ABDEYAZDAN et al,2014;CASTRO et al, 2014).…”

Ultrasound to guided epicutaneo-caval catheter insertion in newborn infants

“…As mentioned above, CXR has a number of disadvantages. To overcome these shortcomings, the ultrasound localization method has been gradually applied in clinical practice in recent years (3,4,(7)(8)(9)(10)(13)(14)(15), and studies or guidelines recommending ultrasound as the "gold standard" for determining the correct tip position have been developed (2)(3)(4).…”