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Cîrstoveanu C, Bratu A, Filip C, Bizubac M. The Role of POCUS and Monitoring Systems during Emergency Pericardial Effusion in the NICU. Life (Basel) 2024; 14:1104. [PMID: 39337888 PMCID: PMC11433190 DOI: 10.3390/life14091104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Central venous catheterization is, now, one of the most routinely used procedures in the NICUs, helping during the care of very sick infants. Pericardial effusion is a very rare but severe complication, with a high mortality. The cases described are part of an ongoing retrospective study where the use of central catheters inserted in our surgical NICU, and its complications is being analyzed. 16 cases over 13 years are presented in this article, varying in severity from mild, self-resolving cases that were discovered during routine cardiac POCUS to cases with important hemodynamic impact associated with cardiac tamponade and cardiac arrest. Due to immediate intervention, only one of the cases led to catheter-related mortality and that was under particular conditions. Our aim is to highlight the severity of this complication, the importance of early intervention, and the impact of a highly technologized unit and widely available cardiac POCUS.
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Affiliation(s)
- Cătălin Cîrstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Alexandra Bratu
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
- Department of Pediatrics, Pediatric Cardiology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Emergency Clinical Hospital for Children, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
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Natile M, Ancora G, D'Andrea V, Pittiruti M, Barone G. A narrative review on tip navigation and tip location of central venous access devices in the neonate: Intracavitary ECG or real time ultrasound? J Vasc Access 2024:11297298241259247. [PMID: 39090995 DOI: 10.1177/11297298241259247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
The proper location of the tip of a central venous access device plays a crucial role in minimizing the risks potentially associated with its use. Recent guidelines strongly recommend preferring real-time, intra-procedural methods of tip location since they are more accurate, more reliable and more cost-effective than post-procedural methods. Intracavitary electrocardiography and real time ultrasound can both be applied in the neonatal setting, but they offer different advantages or disadvantages depending on the type of central venous access device. Reviewing the evidence currently available about the use of these two methods in neonates, in terms of applicability, feasibility and accuracy, it can be concluded that (a) real time ultrasound is the only acceptable methodology for tip navigation for any central venous access device in neonates, (b) intracavitary electrocardiography is the preferred method of tip location for central catheters inserted by ultrasound-guided cannulation of the internal jugular vein or the brachiocephalic vein, and (c) real time ultrasound is the preferred method of tip location for umbilical venous catheters, epicutaneo-cava catheters, and central catheters inserted by ultrasound-guided cannulation of the common femoral vein.
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Affiliation(s)
- Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
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Falay D, Schindler E, Mikus M, Boulos A, Sylvia S, Alina S, Torsten B. Ultrasound-guided supraclavicular cannulation of left brachiocephalic versus right internal jugular vein: Comparative analysis of central venous catheter-associated complications. Paediatr Anaesth 2023; 33:219-228. [PMID: 36350095 DOI: 10.1111/pan.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS Central venous catheters are essential for the management of pediatric cardiac surgery patients. Recently, an ultrasound-guided access via a supraclavicular approach to the brachiocephalic vein has been described. Central venous catheters are associated with a relevant number of complications in pediatric patients. In this study, we evaluated the frequency of complications of left brachiocephalic vein access compared with right internal jugular vein standard access in children undergoing cardiac surgery. METHODS Retrospective analysis of all pediatric cases at our tertiary care university hospital over a two-year period receiving central venous catheters for cardiac surgery. PRIMARY ENDPOINT Frequency of complications associated with central venous catheters inserted via the left brachiocephalic vein vs. right internal jugular vein. Complications were defined as: chylothorax, deep vein thrombosis, sepsis, or delayed chest closure. Secondary endpoints: Evaluation of the insertion depth of the catheter using a height-based formula without adjustment for side used. RESULTS Initially, 504 placed catheters were identified. Following inclusion and exclusion criteria, 480 placed catheters remained for final analysis. Overall complications were reported in 68/480 (14.2%) cases. There was no difference in the frequency of all complications in the left brachiocephalic vein vs. the right internal jugular vein group (15.49% vs. 13.65%; OR = 1.16 [0.64; 2.07]), nor was there any difference considering the most relevant complications chylothorax (7.7% vs. 8.6%; OR = 0.89 [0.39; 1.91]) and thrombosis (5.6% vs. 4.5%; OR = 1.28 [0.46; 3.31]). The mean deviation from the optimal insertion depth was left brachiocephalic vein vs. right internal jugular vein 5.38 ± 13.6 mm and 4.94 ± 15.1 mm, respectively. CONCLUSIONS Among children undergoing cardiac surgery, there is no significant difference between the supraclavicular approach to the left brachiocephalic vein and the right internal jugular vein regarding complications. For both approaches, a universal formula can be used to determine the correct insertion depth.
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Affiliation(s)
- Diyar Falay
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Marian Mikus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Asfour Boulos
- Department of Congenital Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Schroth Sylvia
- Department of Congenital Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Schenk Alina
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Baehner Torsten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.,Department of Anesthesiology and Intensive Care Medicine, Stiftshospital Andernach, Andernach, Germany
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Luister A, Khostwal N, Deindl P, Herrmann J, Singer D, Ebenebe CU. Recommendations for Peripherally Inserted Central Catheter Insertion Depths in Neonates. Neonatology 2023; 120:263-267. [PMID: 36596282 DOI: 10.1159/000528076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Malposition of peripherally inserted central catheters (PICCs) is common. Recommendations for PICC insertion depths are scarce and comprise complex equations. This study aimed to develop diagrams and tables for the recommendation of PICC insertion depths in neonates based on anthropometric parameters. STUDY DESIGN In this retrospective single-center study, the individual optimal PICC insertion depths were correlated with body weight, length, and head circumference. Using linear regression analysis, line charts and tables for the recommendation of PICC insertion depth were generated and compared with previously published recommendations. RESULT PICC insertion depths of 204 infants (gestational age at PICC installation: 24.0-44.9 weeks) with 131 (64%) PICC in the upper extremities and 73 (36%) in the lower extremities were analyzed. Linear logistic regression models revealed R2 values between 0.387 and 0.884. CONCLUSION The charts and table developed in this study enable a fast and accurate determination of recommended PICC insertion depths in neonates.
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Affiliation(s)
- Alexandra Luister
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistreet, Hamburg, Germany
| | - Neda Khostwal
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistreet, Hamburg, Germany
| | - Philipp Deindl
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistreet, Hamburg, Germany
| | - Jochen Herrmann
- Division of Pediatric Radiology, Department of Interventional and Diagnostic Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistreet, Hamburg, Germany
| | - Dominique Singer
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistreet, Hamburg, Germany
| | - Chinedu Ulrich Ebenebe
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistreet, Hamburg, Germany
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Zito Marinosci G, Biasucci DG, Barone G, D'Andrea V, Elisei D, Iacobone E, La Greca A, Pittiruti M. ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients. J Vasc Access 2023; 24:5-13. [PMID: 34256613 DOI: 10.1177/11297298211031391] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.
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Affiliation(s)
- Geremia Zito Marinosci
- UOC di Rianimazione e Neuroanestesia, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Neaples, Italy
| | - Daniele Guerino Biasucci
- Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi di Rimini, Azienda Unità Sanitaria Locale della Romagna, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Wang J, Wang Q, Liu Y, Lin Z, Janjua MU, Peng J, Du J. The incidence and mortality rate of catheter-related neonatal pericardial effusion: A meta-analysis. Medicine (Baltimore) 2022; 101:e32050. [PMID: 36451499 PMCID: PMC9704876 DOI: 10.1097/md.0000000000032050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUD Neonatal pericardial effusion (PCE) is one of the most severe complications of central catheters in neonates with its rapid progression and high mortality. We aim to estimate the overall incidence and mortality of catheter-related neonatal PCE, more importantly, to identify possible predictors for clinical reference. METHODS We searched MEDLINE, Embase, Cochrane Library, Web of Science, china national knowledge infrastructure, Wanfang Data, and Sinomed databases for subject words "central catheter," "neonate," "pericardial effusion" and their random words till June 8, 2020. This meta-analysis is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Possible predictors of occurrences and deaths were extracted and assessed cooperatively. The pooled incidence rate of catheter-related neonatal PCE was calculated using a random effects model. RESULTS Twenty-one cohort studies and 99 cases were eligible. Pooled incidence is 3·8‰[2.2‰, 6.7‰]. Polyurethane catheters generate significantly more neonatal PCE than silicone counterparts (P < .01). 27% of the patients die. The mortality of patients with bradycardia is higher than others (P < .05). Catheters with a guidewire result in more deaths than umbilical venous catheter (UVC) and peripherally inserted central catheters (PICC) (P < .05). Without pericardiocentesis, mortality increases (P < .01). The difference of deaths between reposition and removing the catheter is insignificant (P > .05). CONCLUSION Central catheters in Seldinger Technique (with a guidewire) put neonates at greater risk of PCE and consequent death. Silicone catheters excel at avoiding deadly catheter-related PCE, which could be a better choice in neonatal intensive care units (NICU). When catheter-related PCE occurs, timely diagnosis and pericardiocentesis save lives.
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Affiliation(s)
- Jingyi Wang
- The First Clinical Medical Institute, Hainan Medical University, Hainan, China
| | - Qing Wang
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Yanxia Liu
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Zebin Lin
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Muhammad Usman Janjua
- International Education Institute, Changsha Medical University, Changsha, Hunan, China
| | - Jianxiong Peng
- Medical Administration Department, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Jichang Du
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
- * Correspondence: Jichang Du, Department of Neonatology, Hainan Modern Women and Children’s Hospital, No. 18 Qiongzhou Avenue, Qiongshan District, Haikou, Hainan 571101, P.R. China (e-mail: )
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Liu G, Zhang J, Wang F, Liu H. Fourth thoracic vertebra as landmark for depth of right internal jugular vein catheterization in infants. Sci Rep 2022; 12:14569. [PMID: 36028521 PMCID: PMC9418216 DOI: 10.1038/s41598-022-18787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022] Open
Abstract
The carina is considered a reliable marker for the depth of right internal jugular vein catheterization in infants on chest radiograph. In adult anatomy, the carina is typically located at the level of the fifth thoracic vertebra. We are not aware of a positional relationship between infant carina and thoracic vertebrae. Thus, we evaluated that a vertebral body may be at the same level as carina and can be as radiographic landmarks for the depth of right internal jugular vein catheterization in infants. In this retrospective analysis, 108 infants (aged 1–12 months) who underwent congenital heart surgery between January 1, 2019 and June 30, 2019 were included. We analyzed the post-operative chest radiographs of those who underwent right internal jugular vein catheterization and assessed the positional relationship of the carina and vertebral bodies. We measured the vertical distance of the central venous catheter (CVC) catheter tip from the carina (below the carina 22 mm, it may be close to or into the right atrium). In total, 95 children were enrolled; The carina was located at the third thoracic vertebra in two cases (2%) and at the fourth thoracic vertebra in 93 cases (98%). The distance between the tip of CVC and the carina was 10 (4, 15) mm, and 6.3% (6 cases) had the catheter tip at more than 22 mm below the carina. Most fourth thoracic vertebrae were at the same level as the carina on chest radiographs. Therefore, it has potential as a radiographic landmark for the depth of right internal jugular vein catheterization in infants on chest radiograph.
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Affiliation(s)
- Guoliang Liu
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
| | - Jianmin Zhang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
| | - Fang Wang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China.
| | - Heqi Liu
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
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Grasso F, Capasso A, Pacella D, Borgia F, Salomè S, Capasso L, Raimondi F. Ultrasound Guided Catheter Tip Location in Neonates: A Prospective Cohort Study. J Pediatr 2022; 244:86-91.e2. [PMID: 34971654 DOI: 10.1016/j.jpeds.2021.12.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess point-of-care-ultrasound (POCUS) guided catheter tip location in a neonatal cohort after insertion of percutaneously inserted central catheters (PICCs) from the upper part of the body. STUDY DESIGN This was a prospective, observational study on PICC tip location. Tip site was assessed by radiological landmarks or direct ultrasound (US) visualization of the cardiovascular structures. RESULTS One hundred eighteen PICCs (28Gauge/1French) were studied in 102 neonates (mean postmenstrual age 31 weeks, range 25-43 weeks; mean weight at positioning 1365 g, range 420-4180 g). Feasibility of POCUS guided tip location was 92.3% in our population. Failures were significantly associated with mechanical ventilation (aOR 5.33; 95% CI 1.13-29.5; P = .038). Agreement between US and radiographic methods was found in 88 of 109 cases (80.7%). Fifteen of 21 discordant cases led to a change in clinical management. CONCLUSIONS POCUS guided localization of small bore PICC is a non-invasive and effective alternative to the conventional radiogram. The latter should be recommended when US examination fails to locate the catheter tip.
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Affiliation(s)
- Fiorentino Grasso
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Antonella Capasso
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, Federico II University, Naples, Italy
| | - Francesco Borgia
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Serena Salomè
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Letizia Capasso
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Raimondi
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Barone G, Pittiruti M, Biasucci DG, Elisei D, Iacobone E, La Greca A, Zito Marinosci G, D'Andrea V. Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates. J Vasc Access 2021; 23:679-688. [PMID: 33818191 DOI: 10.1177/11297298211007703] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi di Rimini, AUSL della Romagna, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Daniele G Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Geremia Zito Marinosci
- UOC di Rianimazione e Neuroanestesia, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Neaples, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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[Operation and management guidelines for peripherally inserted central catheter in neonates (2021)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021. [PMID: 33691911 DOI: 10.7499/j.issn.1008-8830.2101087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Peripherally inserted central catheter (PICC) has been widely used in the neonatal intensive care unit (NICU) in recent years, but there are potential risks for complications related to PICC. Based on the current evidence in China and overseas, the operation and management guidelines for PICC in neonates were developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in order to help the NICU staff to regulate the operation and management of PICC.
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Montes-Tapia F, Hernández-Trejo K, García-Rodríguez F, Jaime-Reyes J, Treviño-Garza C, Cárdenas-Del Castillo B, Rodríguez-Balderrama I, de la O-Cavazos M. Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates. J Pediatr Surg 2020; 55:1920-1924. [PMID: 31937448 DOI: 10.1016/j.jpedsurg.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Fernando Montes-Tapia
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Pediatric Surgery, Department of Pediatrics, Monterrey, Mexico.
| | - Karla Hernández-Trejo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Fernando García-Rodríguez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Julio Jaime-Reyes
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Consuelo Treviño-Garza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Barbara Cárdenas-Del Castillo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Neonatology, Department of Pediatrics, Monterrey, Mexico
| | - Isaías Rodríguez-Balderrama
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Neonatology, Department of Pediatrics, Monterrey, Mexico
| | - Manuel de la O-Cavazos
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
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Xu H, Zhu X, Li J, Yao Y, Guo M, Yu T, Xiong X, Huang Z, Miao L, Lin D. Using sternal angle as anatomic landmark for right internal jugular vein catheterization in pediatrics. Acta Anaesthesiol Scand 2020; 64:188-192. [PMID: 31529467 DOI: 10.1111/aas.13474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many formulas based on the patient's height, weight and/or age exist to determine central venous catheter (CVC) depth in children. However, this information is unavailable in some emergency conditions. Therefore, direct methods should be developed to guide catheter position in children. METHODS Eighty patients aged 1-10 y were enrolled from July 2015 to August 2016 and seventy-five were completed; fifty were male, and twenty-five were female. The exclusion criteria were inability to identify the sternal angle or failure to use the right internal jugular vein approach. The catheter was inserted using the right internal jugular vein approach, the distance from the skin puncture point to the midpoint of the sternal angle plane was measured, and the catheter tip was positioned to this distance minus 1 cm. Chest radiography were performed for those children after catheter insertion. The relative position between the catheter tip and carina was confirmed and the longitudinal distance from the catheter tip to the carina was calculated on radiographic images, and related complications were recorded. RESULTS All catheter tips were above the carina, and the average distance from the catheter tip to the carina was 9.8 mm. No patients experienced serious complications. CONCLUSION The sternal angle is a useful and reliable anatomic landmark for guiding CVC position in children. Using this landmark, the catheter can be quickly and conveniently placed at a safety position in right internal jugular vein, especially in some emergency conditions.
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Affiliation(s)
- Hui Xu
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Xiaoqiu Zhu
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Jin Li
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Yiyi Yao
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Mingyan Guo
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Taihui Yu
- Department of Radiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Xilin Xiong
- Department of Pediatrics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Liping Miao
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Daowei Lin
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
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Kolaček S, Puntis JWL, Hojsak I. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access. Clin Nutr 2018; 37:2379-2391. [PMID: 30055869 DOI: 10.1016/j.clnu.2018.06.952] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- S Kolaček
- Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | | | - I Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia
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Chaskar V, Karnik PP, Dave NM, Garasia M. Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study. Turk J Anaesthesiol Reanim 2018; 46:116-120. [PMID: 29744246 DOI: 10.5152/tjar.2018.32748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Central venous cannulation of the internal jugular vein is difficult in paediatric patients because of the small size of the vein and anatomic variations. Many studies have shown the accuracy of various formulae for calculating the depth of placement. The aim of this study was to assess the most reliable method for central venous catheter (CVC) tip placement in paediatric patients. Methods Sixty-nine patients in the age groups from 0 to 12 years were divided in three groups for three published techniques for catheter tip placement. In Group E, catheter tip was placed at the distance measured from entry point to sternal angle. In Groups P and H, Peres and trans-oesophageal echocardiography (TEE)-derived formulae, respectively, were used for catheter placement. Post-procedure chest radiograph was performed for all patients, and tip position was recorded. Appropriate catheter tip position was considered just above or at the level of carina. The number of attempts and complications were recorded. Chi-square test was used for statistical analysis. Results Of 69 patients, 65% of patients in Group P, 52% in group H and 91% in group E had appropriate CVC tip placement. The chi-square test showed that the difference in the number of patients with appropriately positioned CVC tip among the three groups was statistically significant (p=0.0134), with intergroup analysis showing Group E to be superior. One patient had an episode of arrhythmia during guide wire insertion and was resuscitated successfully. Conclusion Catheter tip placement by external distance or landmark technique is a more accurate method for catheter placement than the Peres and TEE-based formulae. It does not require measurement of patients' height and reduces the chances of repositioning of catheter.
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Affiliation(s)
- Vaishali Chaskar
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | | | - Nandini Malay Dave
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | - Madhu Garasia
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
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Capasso A, Mastroianni R, Passariello A, Palma M, Messina F, Ansalone A, Bernardo I, Brescia D, Crispino F, Grassia C, Romano A, Ausanio G. The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study. J Vasc Access 2018; 19:542-547. [DOI: 10.1177/1129729818761292] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The neonatologists of Sant’Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning. Patients and methods: We enrolled 39 neonates (1–28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head–neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates. Results: No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction–target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected. Conclusion: We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if “peak” P wave is detected.
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Affiliation(s)
- Antonella Capasso
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Rossella Mastroianni
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Annalisa Passariello
- Department of Translational Medical Science, University of Naples “Federico II,” Naples, Italy
- Department of Pediatric Oncology, Santobono-Pausilipon Hospital, Naples, Italy
| | - Marta Palma
- Department of Translational Medical Science, University of Naples “Federico II,” Naples, Italy
| | - Francesco Messina
- Neonatal Intensive Care Unit, “Villa Betania” Evangelical Hospital, Naples, Italy
| | - Antonella Ansalone
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Italo Bernardo
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Daniela Brescia
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Francesco Crispino
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Carolina Grassia
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Attilio Romano
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Gaetano Ausanio
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
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Chin JH, Lee EH, Kim JI, Choi IC. Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study. BMC Anesthesiol 2017; 17:56. [PMID: 28388941 PMCID: PMC5383961 DOI: 10.1186/s12871-017-0347-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae. METHODS The patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon's direct inspection in the surgical field was performed. The range -1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction. RESULTS A total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon's inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05-0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients. CONCLUSIONS Preoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter. TRIAL REGISTRATION This study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477) .
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Affiliation(s)
- Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Jong-Il Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Tarr GP, Pak N, Taghavi K, Iwan T, Dumble C, Davies-Payne D, Mirjalili SA. Defining the surface anatomy of the central venous system in children. Clin Anat 2015; 29:157-64. [PMID: 26518452 DOI: 10.1002/ca.22663] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/20/2015] [Accepted: 10/28/2015] [Indexed: 11/06/2022]
Abstract
Pediatric emergency physicians, pediatric critical care specialists, and pediatric surgeons perform central venous catheterization in many clinical settings. Complications of the procedure are not uncommon and can be fatal. Despite the frequency of application, the evidence-base describing the surface landmarks involved is missing. The aim of the current study was to critically investigate the surface markings of the central venous system in children. The superior vena cava/right atrial (SVC/RA) junction, superior vena cava (SVC) formation, and brachiocephalic vein (BCV) formation were examined independently by two investigators. Three hundred computed tomography (CT) scans collected across multiple centers were categorized by age group into: 0-3 years, 4-7 years, and 8-11 years. Scans with pathology that distorted or obscured the regional anatomy were excluded. The BCV formation was commonly found behind the ipsilateral medial clavicular head throughout childhood. This contrasts with the variable levels of SVC formation, SVC length, and SVC/RA junction. In the youngest group, SVC formation was most commonly at the second costal cartilage (CC), but moved to the first CC/first intercostal space (ICS) as the child grew. The SVC/RA junction was at the fourth CC in the youngest group and moved to the third CC/third ICS as the child grew. This study demonstrates the variable anatomy of SVC formation and the SVC/RA junction with respect to rib level. This variability underscores the unreliability of surface anatomical landmarks of the SVC/RA junction as a guide to catheter tip position.
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Affiliation(s)
- Gregory P Tarr
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Neda Pak
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Taghavi
- Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand
| | - Tom Iwan
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte Dumble
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - S Ali Mirjalili
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Simple Formula to Place Central Venous Catheter Tip at T6 After Surgical Cutdown in Neonates. Int Surg 2015. [DOI: 10.9738/intsurg-d-15-00032.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this paper was to develop a generally applicable formula to estimate correct catheter length after surgical cutdown in right internal jugular vein (RIJV) in neonates. The carina has been utilized as an anatomic landmark indicating superior vena cava-right atrium junction (SVC-RA) for the optimal placement of the central venous catheter (CVC) tip position. However, this landmark may not be accurate in neonates. Recent researches noted that the sixth vertebral body (T6) could better serve as a new landmark of SVC-RA in neonates and smaller children. We prospectively performed RIJV cutdown. For a controlled and reproducible surgical procedure, the venous entry site was consistently taken as the point where the omohyoid muscle crosses the RIJV. On intraoperative infantogram, the vertical distance between the venous entry site and T6 was measured and the catheter was inserted to this length. A linear regression model was investigated using the following variables to elicit the best prediction model for catheter length: gestational age, postconceptional age, birth weight, and weight at operation. Weight at operation best correlated with the measured CVC length (R2 = 0.916, P = 0.00), and the following linear equation was derived: estimated CVC length (mm) = 9 × [weight at operation (Kg)] + 30. There was no statistically significant difference between measured and estimated CVC length. With this formula, the optimal catheter length could easily be estimated when considering RIJV cutdown.
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Evaluation of the Correct Position of Peripherally Inserted Central Catheters: Anatomical Landmark vs. Electrocardiographic Technique. J Vasc Access 2015; 16:394-8. [DOI: 10.5301/jva.5000431] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to verify as early as possible the correct positioning of the peripherally inserted central catheter (PICC) tip in order to reduce complications due to possible malpositioning. The ECG-guided technique proved to be reliable, easy to carry out, straightforward, low-cost and allows us to recognize an incorrect or a suboptimal positioning throughout the procedure. The purpose of this study is to compare two methods used during the PICC insertion so as to prevent catheter malpositioning; the first study estimates the catheter length by the landmark method (based on cutaneous anatomical landmarks, CALs) with the addition of the postprocedural verification of tip location by chest X-Ray (CxR), whereas the second method of intraprocedural tip location is based on the observation of the morphological variations of the P wave (ECG-guided technique) with the addition of the postprocedural verification by CxR. Methods From 2010 to 2012, 90 PICCs were positioned, 48 using the anatomical landmarks and 42 using the ECG technique. Results Twenty-five percent of the catheters positioned with the anatomical landmark technique did not reach the correct position of the tip in SVC; of these, 6.25% were placed in an aberrant position and others in a suboptimal position. Of the 42 PICCs positioned with the ECG technique, only in three cases (equal to 7.14%), a suboptimal position of the tip was observed, whereas there was no case of aberrant positioning. Conclusions The ECG technique represents an accurate, low-cost and safe technique to verify the correct positioning of the tip. The use of the ECG allowed a more correct positioning in terms of catheter tip-carina distance and catheter tip-tracheobronchial angle, and in no patient was it necessary to place a catheter again.
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Proper Tip Position of Central Venous Catheter in Pediatric Patients. J Vasc Access 2015; 16:399-402. [DOI: 10.5301/jva.5000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/20/2022] Open
Abstract
Background In this study, we analyzed the thin-section pulmonary computed tomographic (CT) angiogram scans of pediatric patients to determine the normative length of superior vena cava (SVC) and the distance between carina and cephalad of SVC or cavocatrial junction. Methods Consecutive child patients, under 13 years of age in whom the central catheters were inserted under ultrasound guidance from December 2004 to April 2005 were evaluated retrospectively. Results In the 14 cases, the mean age was 7.2 ± 4.21 years. The mean length and diameter of the SVC in the pediatric patients were 45.6 ± 23.03 and 13.7 ± 3.62 mm, respectively. The distance from the carina to the cavoatrial junction was 22.0 ± 9.98 mm. The mean distance from the superior margin of the SVC to the carina was 23.7 ± 16.70 mm. The mean distance from the carina to the catheter tip was 38.9 ± 18.60 mm. In no case was the cavoatrial junction cephalad with respect to the carina. Carina to cavoatrial junction junction was significantly associated with age, height, and weight, respecitively (r = 0.750; p = 0.005, r = 0.763; p = 0.004; r = 0.777; p = 0.003). Conclusions The carina is a good landmark for the upper border of the cavoatrial junction. Length of carina to cavoaterial juction was associated with age. The rates of malposition and re-intervention and the patient's exposure to radiation can be reduced by using ultrasound during the catheter insertion.
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The Intracavitary ECG Method for Positioning the Tip of Central Venous access Devices in Pediatric Patients: Results of an Italian Multicenter Study. J Vasc Access 2014; 16:137-43. [DOI: 10.5301/jva.5000281] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The Italian Group for Venous Access Devices (GAVeCeLT) has carried out a multicenter study investigating the safety and accuracy of intracavitary electrocardiography (IC-ECG) in pediatric patients. Methods We enrolled 309 patients (age 1 month-18 years) candidate to different central venous access devices ( VAD) - 56 peripherally inserted central catheters (PICC), 178 short term centrally inserted central catheters (CICC), 65 long term VADs, 10 VADs for dialysis - in five Italian Hospitals. Three age groups were considered: A (<4 years, n = 157), B (4-11 years, n = 119), and C (12-18 years, n = 31). IC-ECG was applicable in 307 cases. The increase of the P wave on IC-ECG was detected in all cases but two. The tip of the catheter was positioned at the cavo-atrial junction (CAJ) (i.e., at the maximal height of the P wave on IC-ECG) and the position was checked during the procedure by fluoroscopy or chest x-ray, considering the CAJ at 1-2 cm (group A), 1.5-3 cm (group B), or 2-4 cm (group C) below the carina. Results There were no complications related to IC-ECG. The overall match between IC-ECG and x-ray was 95.8% (96.2% in group A, 95% in group B, and 96.8% in group C). In 95 cases, the IC-ECG was performed with a dedicated ECG monitor, specifically designed for IC-ECG (Nautilus, Romedex): in this group, the match between IC-ECG and x-ray was 98.8%. Conclusions We conclude that the IC-ECG method is safe and accurate in the pediatric patients. The applicability of the method is 99.4% and its feasibility is 99.4%. The accuracy is 95.8% and even higher (98.8%) when using a dedicated ECG monitor.
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Defining Central venous Line Position in Children: Tips for the Tip. J Vasc Access 2014; 16:77-86. [DOI: 10.5301/jva.5000285] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to analyse literature related to the position of centrally inserted central venous catheters and to review topics related to assessment of tip position of those catheters in children. Applications of specific techniques to PICCs (Periferally Inserted Central Catheters) and umbilical venous catheter will also be reviewed. Methods Analysis of 68 original manuscripts, 42 specifically related to the paediatric population, 26 related to the adult population. The papers analysed were published between 1949 and 2014; all articles were in English except one in Italian and one in German. Results From the analysed literature, most of the guidelines recommend tip positioning at a level between the superior vena cava and the right atrium. Several methods have been described to evaluate tip position in the paediatric population, but none of those is considered completely reliable. The standard methods used to identify catheter tip position are radiography and fluoroscopy, but no specific landmark can be recommended in the paediatric population. The ultrasonographic approach has been investigated mainly for PICCs positioning in the neonatal population. The electrocardiographic method has been evaluated in the general paediatric population. Conclusions No specific recommendation can be given due to the low level of evidence. Ultrasound and ECG (electrocardiogram) techniques are a potential alternative to chest X-ray and further studies should be implemented to establish them. A wider application of these techniques may reduce neonatal and paediatric exposure to radiations and additionally reduce costs.
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Witthayapraphakorn L, Khositseth A, Jiraviwatana T, Siripornpitak S, Pornkul R, Anantasit N, Vaewpanich J. Appropriate length and position of the central venous catheter insertion via right internal jugular vein in children. Indian Pediatr 2013; 50:749-52. [DOI: 10.1007/s13312-013-0217-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/26/2012] [Indexed: 10/26/2022]
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WESTERGAARD B, CLASSEN V, WALTHER-LARSEN S. Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand 2013; 57:278-87. [PMID: 23252685 DOI: 10.1111/aas.12024] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 02/06/2023]
Abstract
Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search of the current literature. Although the literature is heterogeneous with few randomised studies, PICCs emerge as a safe and valuable option for intermediate- to long-term central venous access in children both in and out of hospital. Insertion can often be performed in light or no sedation, with little risk of perioperative complications. Assisted visualisation, preferably with ultrasound, yields high rates of insertion success. With good catheter care, rates of mechanical, infectious and thrombotic complications are low and compare favourably with those of traditional central venous catheters. Even in the case of occlusion or infection, fibrinolytics and antibiotic locks often allow the catheter to be retained.
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Affiliation(s)
- B. WESTERGAARD
- Department of Anaesthesia, Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen; Denmark
| | - V. CLASSEN
- Department of Anaesthesia, Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen; Denmark
| | - S. WALTHER-LARSEN
- Department of Anaesthesia, Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen; Denmark
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The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. J Vasc Access 2013; 13:357-65. [PMID: 22328361 DOI: 10.5301/jva.2012.9020] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of this multicenter study was to assess the feasibility, safety, and accuracy of the intracavitary ECG method for real-time positioning of the tip of different types of central venous catheters. METHODS A total of 1444 catheter insertions in adult patients were studied in eight Italian centers (539 ports, 245 PICCs, 325 tunneled CVCs, 335 non-tunneled CVCs). Patients with no visible P wave at the standard baseline ECG were excluded. Depending on the type of catheter and its purpose, the target was to position the tip either (a) at the cavo-atrial junction, or (b) in the lower third of the superior vena cava, or (c) in the upper part of the atrium. The final position was verified by a post-procedural chest x-ray. RESULTS The method was feasible in 99.3% of all cases. There were no complications potentially related to the method itself. At the final x-ray control, 83% of all tips were positioned exactly at the target; 12.4% were positioned within 1-2 cm from the target, but still in a correct central position; only 3.8% were malpositioned. The mismatch between intra-procedural ECG method and post-procedural x-ray was significantly lower when the x-ray was taken in supine position. CONCLUSIONS Our multicenter study confirms that the intracavitary ECG method for real time verification of tip position is accurate, safe, feasible in all adult patients and applicable to any type of short-term or long-term central venous access device.
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Detaille T, Pirotte T, Veyckemans F. Vascular access in the neonate. Best Pract Res Clin Anaesthesiol 2011; 24:403-18. [PMID: 21033016 DOI: 10.1016/j.bpa.2010.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Up to recently, inserting venous or arterial 'lines' in the neonate was essentially based on clinical skill and experience. The recent advent of portable ultrasound (US) machines with paediatric probes has resulted in the development of new approaches that, if correctly learned and used, should allow quicker and safer vascular access in this population. Both classic and new techniques are reviewed on the basis of literature and authors' experience.
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Affiliation(s)
- Thierry Detaille
- Department of Anesthesiology, Cliniques Universitaires St. Luc, Catholic University of Louvain Medical School, Avenue Hippocrate 10-1821, B 1200 Brussels, Belgium
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Na HS, Kim JT, Kim HS, Bahk JH, Kim CS, Kim SD. Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients. Br J Anaesth 2009; 102:820-3. [PMID: 19380312 DOI: 10.1093/bja/aep078] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients. METHODS Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as 'Point I'. The sternal head of the right clavicle was called 'Point A' and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called 'Point B'. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System. RESULTS The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients' age, height, and weight. CONCLUSIONS The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.
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Affiliation(s)
- H S Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
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Rakza T, Bouissou A, Laffargue A, Fily A, Diependaele J, Dalmas S. Le cathétérisme veineux central chez l’enfant. Arch Pediatr 2008; 15:1454-63. [DOI: 10.1016/j.arcped.2008.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 04/10/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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Inagawa G, Ka K, Tanaka Y, Kato K, Tanaka M, Miwa T, Morimura N, Koyama Y, Hiroki K. The carina is not a landmark for central venous catheter placement in neonates. Paediatr Anaesth 2007; 17:968-71. [PMID: 17767633 DOI: 10.1111/j.1460-9592.2007.02258.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac tamponade is rare but one of the most serious complications in relation to central venous catheters (CVC). The tip of the CVC should be placed outside the pericardium to avoid tamponade. In adults, the carina is always located above the pericardium; therefore, the carina is a reliable landmark for CVC placement. We examined whether the carina could also be an adequate landmark for CVC placement in neonates. METHODS The study was conducted using nine fresh neonatal cadavers. The longitudinal distance between the carina and the pericardium as it transverses the superior vena cava (the pericardial reflection: PR) was measured. RESULTS The median postconceptional age (gestational age in weeks + weeks after delivery) at autopsy was 35 (range: 23-42) weeks. The PR was located at a distance of 4 mm above to 5 mm below the carina. Unlike in adults, the position of the PR varies in relation to the carina in neonates. In seven of the nine subjects, the location of the PR was above the carina. CONCLUSIONS In neonates, the carina is not always located above the pericardium, as it is in adults; therefore, the carina is not an appropriate landmark for CVC placement.
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Affiliation(s)
- Gaku Inagawa
- Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan.
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Abstract
In neonates and infants, arterial and central venous catheters are of vital importance to optimize perioperative surveillance during surgery as well as postoperative care in the intensive care unit. The insertion of umbilical venous (UVC) and umbilical arterial catheters (UAC) in neonates in the first days of life is relatively simple and associated with a low procedure-related risk. As with other centrally placed catheters, correct positioning must be verified and the catheters should not be used for more than 5-7 days. Peripherally inserted central catheters (PICC) are commonly used in neonates and can be an alternative to conventional central venous lines in older infants. In order to minimize the risk associated with catheter malposition, correct position must always be verified by appropriate imaging studies or ECG guidance. Surgically placed Broviac catheters are mainly used in patients with a long-term need for central venous access. Finally, it has been shown that adherence to strict guidelines for insertion and handling can significantly reduce catheter-associated infections.
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Affiliation(s)
- M Stocker
- Neonatologische und pädiatrische Intensivpflegestation, Kinderspital, 6000 Luzern, Schweiz
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