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Zini T, Corso L, Mazzi C, Baraldi C, Nieddu E, Rinaldi L, Miselli F, Bedetti L, Spaggiari E, Rossi K, Berardi A, Lugli L. Ultrasound-Guided Centrally Inserted Central Catheter (CICC) Placement in Newborns: A Safe Clinical Training Program in a Neonatal Intensive Care Unit. CHILDREN (BASEL, SWITZERLAND) 2024; 11:395. [PMID: 38671612 PMCID: PMC11048839 DOI: 10.3390/children11040395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions. METHODS We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns. RESULTS The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26-40; median birth weight 1200 g, IQR 622-2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues. CONCLUSIONS Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff.
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Affiliation(s)
- Tommaso Zini
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Lucia Corso
- Post-Graduate School of Paediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Cinzia Mazzi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Cecilia Baraldi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Elisa Nieddu
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Laura Rinaldi
- Anaesthesia and Intensive Care Medicine, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Francesca Miselli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Luca Bedetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Eugenio Spaggiari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Katia Rossi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
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D’Andrea V, Cascini V, Russo R, Perri A, Prontera G, Ancora G, Vento G, Lisi G, Barone G. The Role of Ultrasound in Epicutaneo-Caval Catheter Insertion in Neonates: Systematic Review, Meta-Analysis and Future Perspectives. Diagnostics (Basel) 2023; 13:2850. [PMID: 37685388 PMCID: PMC10487192 DOI: 10.3390/diagnostics13172850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Chest and abdominal X-rays after the insertion of an epicutaneo-caval catheter in infants are the standard method of checking the tip location in many neonatal intensive care units. The role of ultrasound in the tip location of the epicutaneo-caval catheter in neonates has been the subject of many recent studies. This systematic review investigates the accuracy of epicutaneo-caval catheter tip location by comparing ultrasound and conventional radiology. We performed a systematic literature search in multiple databases. The selection of studies yielded nineteen articles. The systematic review and meta-analysis were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis). The analyses showed that ultrasound is a better imaging technique for epicutaneo-caval catheter tip location in the neonatal intensive care unit than conventional radiology. By improving operator training and selecting a standardized echography protocol, ultrasound could become the gold standard for visualizing the epicutaneo-caval catheter tip in the neonatal intensive care unit. This would have some important benefits: (1) increased accuracy in tip location (2); a more rapid use of the central venous access (3); and a significant reduction in radiation exposure.
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Affiliation(s)
- Vito D’Andrea
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Valentina Cascini
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Giorgia Prontera
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
- Pediatric Surgery Unit, Department of Medicine and Aging Science, “G. D’Annunzio University”, 66100 Chieti, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
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Doyle SC, Bergin NM, Young R, England A, McEntee MF. 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. Pediatr Radiol 2022; 52:2421-2430. [PMID: 35511256 PMCID: PMC9616767 DOI: 10.1007/s00247-022-05379-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chest radiography after peripherally inserted central catheter insertion in infants is the reference standard method for verifying catheter tip position. The utilisation of ultrasound (US) for catheter placement confirmation in the neonatal and paediatric population has been the focus of many recent studies. OBJECTIVE In this systematic review we investigated the diagnostic accuracy of US for peripherally inserted central catheter tip confirmation in infants in the neonatal intensive care unit (NICU) MATERIALS AND METHODS: We conducted a systematic literature search of multiple databases. The study selection yielded eight articles, all of which had acceptable quality and homogeneity for inclusion in the meta-analysis. Sensitivity and specificity values were reported together with their respective 95% confidence intervals (CI). RESULTS After synthesising the eligible studies, we found that US had a sensitivity of 95.2% (95% CI 91.9-97.4%) and specificity of 71.4% (95% CI 59.4-81.6%) for confirming catheter tip position. CONCLUSION Analyses indicated that US is an excellent imaging test for localising catheter tip position in the NICU when compared to radiography. Ultrasonography is a sensitive, specific and timely imaging modality for confirming PICC tip position. In cases where US is unable to locate malpositioned PICC tips, a chest or combined chest-abdominal radiograph should be performed.
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Affiliation(s)
- Shauna C Doyle
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
| | - Niamh M Bergin
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland.
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
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Motz P, Do J, Lam T, DiBlasi RM, Fang T, Kelly K, DiGeronimo R, Billimoria ZC. Decreasing radiographs in neonates through targeted quality improvement interventions. J Perinatol 2020; 40:330-336. [PMID: 31844185 PMCID: PMC7223959 DOI: 10.1038/s41372-019-0565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our aim was to decrease radiograph use for monitoring placement of peripherally inserted central catheters (PICC) and endotracheal tubes (ETT) in neonates admitted to the neonatal intensive care unit (NICU) by 20% from November 2017 to November 2018. STUDY DESIGN We carried out three Plan-Do-Study-Act (PDSA) cycles: (1) implementation of a radiograph protocol emphasizing ideal patient positioning, standard radiograph views and frequency, (2) standardizing ETT depth using the NRP guidelines, and (3) implementation of an institution specific ETT depth guideline. RESULTS The pre-intervention radiographs per PICC day was 0.86 versus a post-intervention value of 0.46 (P = 0.004). The pre-intervention radiographs per ETT day was 1.45 versus a post-intervention value of 1.07 (P = 0.002). CONCLUSIONS Our multidisciplinary NICU team performed a QI project, which resulted in more than a 20% decrease in the number of radiographs used for monitoring placement of PICCs and ETTs.
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Affiliation(s)
- Patrick Motz
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Julie Do
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Teresa Lam
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Robert M. DiBlasi
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Tim Fang
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Karen Kelly
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Robert DiGeronimo
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Zeenia C. Billimoria
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
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Motz P, Von Saint Andre Von Arnim A, Iyer RS, Chabra S, Likes M, Dighe M. Point-of-care ultrasound for peripherally inserted central catheter monitoring: a pilot study. J Perinat Med 2019; 47:991-996. [PMID: 31605580 DOI: 10.1515/jpm-2019-0198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
Objective To assess the feasibility and accuracy of point-of-care ultrasound (POCUS) in monitoring peripherally inserted central catheter (PICC) location in neonates by non-radiologist physicians. Methods A prospective cohort study compared PICC localization by ultrasound in neonates with a recent radiograph. The ultrasound exam was performed using a standardized protocol with 13-6 MHz linear and 8-4 MHz phased array transducers by a neonatal-perinatal fellow who was blinded to PICC location on the radiograph. Results Of the 30 neonates included, 96.6% (n = 29) were preterm, with 63.3% (n = 19) weighing <1500 g. Nighty-four percent (n = 94) of ultrasound scans matched the radiograph report. The protocol had a sensitivity of 0.97, specificity of 0.66 and positive predictive value of 0.98. Conclusion Limited ultrasound exams to monitor PICC position in neonates using a standardized protocol by non-radiologist physicians are feasible and accurate in a single ultrasound user. Further study in multiple providers is needed before widespread use.
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Affiliation(s)
- Patrick Motz
- Neonatal-Perinatal Fellow, Department of Neonatology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | | | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Shilpi Chabra
- Department of Neonatology, University of Washington, Seattle, USA
| | - Maggie Likes
- Department of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA, USA
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