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D'Andrea V, Prontera G, Cota F, Russo R, Barone G, Vento G. Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Epicutaneo-Caval Catheter Placement in Neonates. Am J Perinatol 2024; 41:e1183-e1189. [PMID: 36693388 DOI: 10.1055/s-0043-1760744] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Epicutaneo-caval catheters (ECCs) are essential for the care of sick infants who require long-term medical and nutritional management. The aim of this study was to investigate the use of real-time ultrasound as an alternative to X-rays to reduce the incidence of primary malpositions during catheter insertion. STUDY DESIGN Data on ECCs were retrospectively collected in a tertiary neonatal intensive care unit. Catheter were analyzed considering the tip location technique (standard chest-abdominal radiograph vs real-time ultrasound) RESULTS: A total of 248 ECCs were analyzed. Of these, 118 catheters had primary malposition (47.6%). The tip of 165 catheters was assessed using standard chest-abdominal X-rays and 107 (64.8%) were found to be in an inappropriate location. In the group of 83 catheters that were placed using real-time ultrasound for tip location, only 11 catheters (13.2%) had primary malposition. The rate of malposition among the two groups showed a statistically significant difference (p < 0.001). Hypothetically, 300 chest X-rays could have been saved if real-time ultrasound had been used to locate the tip, reducing radiation exposure to infants. CONCLUSION The use of a real-time ultrasound may be beneficial in reducing primary catheter malpositions compared with conventional radiography. In addition, secondary malpositions and catheter-related complications can be monitored over time. KEY POINTS · Conventional radiology cannot be considered the "gold standard" for ECC tip location.. · Ultrasound is more accurate and reduces insertion time reducing the rate of primary malposition.. · Ultrasound can be performed in real time and it is the best technique for ECC tip location in infants..
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, Rimini, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Trinh HT, Nguyen TT, Nguyen TT. Cardiac Tamponade Due to Pericardial Effusion Following Peripherally Inserted Central Catheter: A Single-Institution Case Series. Cureus 2024; 16:e56403. [PMID: 38638757 PMCID: PMC11025877 DOI: 10.7759/cureus.56403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Although the use of peripherally inserted central catheters (PICCs) has many advantages, misplacement can lead to serious life-threatening complications such as pericardial effusion (PCE) and cardiac tamponade (CT). This report aims to describe four cases of CT resulting from misplaced PICC, which were successfully managed. METHODS Retrospective analysis of neonates who required PICC insertion and had PCE leading to CT in the Neonatal Intensive Care Unit (NICU) at The Children's Hospital 2, Ho Chi Minh City, Vietnam, during the year 2022. RESULTS Four cases involved preterm infants at 28-30 weeks gestational age, weighing between 900-1,500 grams. The PCE/CT developed between 3 and 24 days following PICC insertion. The abrupt onset with clinical manifestations that showed hemodynamic instability included sudden deterioration, lethargy, apnea, bradycardia, pale skin, and cardiovascular collapse. We use cardiac point of care ultrasound (POCUS) to assess the condition of these patients and guide the pericardiocentesis procedure. The analysis of the aspirated fluid used for PCE/CT treatment is consistent with the component of parenteral nutrition. No deaths were encountered. CONCLUSION Neonates presenting sudden deterioration following PICC insertion should undergo POCUS to prompt identifying PCE/CT. Timely diagnosis via POCUS, prompt pericardiocentesis, and prevention of misplaced PICC-associated serious complications are crucial. Monitoring of the PICC position twice a week is recommended to avoid life-threatening complications. Additionally, incorporating POCUS for identifying the tip of PICC rather than relying solely on X-ray should be considered in the current protocol.
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Affiliation(s)
- Ha T Trinh
- Neonatal Intensive Care Unit, Children's Hospital 2, Ho Chi Minh City, VNM
| | - Thien T Nguyen
- Neonatal Intensive Care Unit, Children's Hospital 2, Ho Chi Minh City, VNM
| | - Tinh T Nguyen
- Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, VNM
- Neonatal Intensive Care Unit, Children's Hospital 2, Ho Chi Minh City, VNM
- Neonatology, University Medical Center, Ho Chi Minh City, VNM
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3
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Kumar Boddu P, Sanket J, Sanjay C, Sanjeev A, Girija N. An Infant with an Unusual Location of a Peripherally Inserted Central Catheter. Neoreviews 2023; 24:e825-e828. [PMID: 38036447 DOI: 10.1542/neo.24-12-e825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Praveen Kumar Boddu
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
- Division of Neonatal-Perinatal Medicine
| | - Jani Sanket
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
- Division of Neonatal-Perinatal Medicine
| | - Chawla Sanjay
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
- Division of Neonatal-Perinatal Medicine
| | - Aggarwal Sanjeev
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
- Division of Pediatric Cardiology, Central Michigan University, Mt Pleasant, MI
| | - Natarajan Girija
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
- Division of Neonatal-Perinatal Medicine
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Amer R, Rozovsky K, Elsayed Y, Bunge M, Chiu A. The utility of point-of-care ultrasound protocol to confirm central venous catheter placement in the preterm infant. Eur J Pediatr 2023; 182:5079-5085. [PMID: 37665336 DOI: 10.1007/s00431-023-05172-0] [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: 06/15/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
Central vascular access is frequently required for preterm infants. Confirmation of positioning of central line is typically on chest and abdominal radiographs; POCUS is a relatively novel diagnostic method. Misdiagnosis is the main concern limiting use of this modality. The aim of this study is to validate our standard protocol accuracy in locating the central catheter position by correlating catheter position as determined by POCUS with radiographs. Premature babies < or equal to 30 weeks gestation who had peripheral central lines or surgical lines were enrolled. Confirmation of line position by radiographs was compared to images obtained through a specific US protocol technique. The operator of US exam was blinded to the radiograph findings. All images were reviewed by two radiologists who were blinded to the radiograph findings. 35 central line placements were assessed. 22 lines were inserted in the UL, and 13 were inserted in the LL with a total of 91 ultrasound scans and radiographs. The position of the line was interpreted as normal in 79/91 scans with interpreter reliability of [Formula: see text]=0.778 (p < 0.001), sensitivity of 0.83 and specificity of 0.96, and positive predictive value of 0.77 and negative predictive value of 0.97. There was no significant difference between the ultrasound interpretation and the radiograph interpretation of UL and LL. Conclusion: The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants. What is Known: • POCUS is a reliable tool assessing the central line positions in preterm infants. What is New: • The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants.
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Affiliation(s)
- Reem Amer
- Pediatrics Department, McMaster University, Hamilton, Canada.
| | - Katya Rozovsky
- Radiology Department, University of Manitoba, Winnipeg, Canada
| | - Yasser Elsayed
- Pediatrics Department, University of Manitoba, Winnipeg, Canada
| | - Martin Bunge
- Radiology Department, University of Manitoba, Winnipeg, Canada
| | - Aaron Chiu
- Pediatrics Department, University of Manitoba, Winnipeg, Canada
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5
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Köstekci YE, Bayram Ö, Mertek S, Bakhtiyarzada J, Aydın A, Yılmaz MM, Murt B, Demirtaş F, Ramoğlu MG, Okulu E, Erdeve Ö, Uçar T, Atasay B, Eyileten Z, Arsan S. Complications of epicutaneo-caval catheters: Pericardial effusion and cardiac tamponade in three preterm infants. J Vasc Access 2023:11297298231198011. [PMID: 37731340 DOI: 10.1177/11297298231198011] [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: 09/22/2023] Open
Abstract
In the neonatal intensive care units (NICU), epicutaneo-caval catheters (ECCs) are common alternative vascular routes. Pericardial effusion (PCE) and cardiac tamponade (CT) are rare but serious complications in infants with ECCs. It may be asymptomatic or present with a variety of significant clinical signs, including dyspnea, bradycardia, sudden asystole, and hypotension. If untreated, PCE can be fatal. This report presents, three cases of ECC-associated PCE/CT during NICU stay. All three patients were born before 30 weeks of gestation and weighed less than 1500 g. Echocardiography was used for diagnosis all patients. PCE/CT was detected incidentally in one patient and after hemodynamic deterioration in the other two. In one patient, CT was developed due to catheter malposition, and the other two patient, the catheter tip was found in the right atrium. PCE did not recur in any of the patients after pericardial fluid was drained and the catheters were removed. No PCE/CT-related deaths were observed. In all three patients, X-ray was used to evaluate the location of the catheter tips. However, after clinical deterioration, echocardiography showed that in the first two cases the tips were actually in the right atrium. Real-time ultrasound was suggested with strong evidence to evaluate the location of the catheter tip and to detect secondary malapposition. PCE/CT should be considered in the presence of unexplained and refractory respiratory distress, abnormal heart rate and blood pressure, and metabolic acidosis in a neonate with ECC. Early diagnosis and prompt pericardiocentesis are essential to reduce mortality and improve prognosis. Prospective studies with educational interventions should be designed to demonstrate that the use of point-of-care ultrasound (POCUS) can be easily acquired and may reduce complications.
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Affiliation(s)
- Yasemin Ezgi Köstekci
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Bayram
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Saniye Mertek
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Jeyhun Bakhtiyarzada
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Alperen Aydın
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Mustafa Yılmaz
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Begüm Murt
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ferhan Demirtaş
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Okulu
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Begüm Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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6
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Contreras J, Stimpson A, Ahmed I, Irvine DJ, Whittington AR. Developing Echogenic Materials as Catheters for Use with Ultrasound. ACS Biomater Sci Eng 2022; 8:1312-1319. [PMID: 35171551 DOI: 10.1021/acsbiomaterials.1c01323] [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: 11/29/2022]
Abstract
Patients with peripherally inserted central catheters (PICCs) are routinely discharged with the catheters in place. These patients experience complications due to undetected thrombosis or accidental dislodgement, with tracking through limited X-ray imaging. Developing catheters with the capability to be tracked without the need for X-ray imaging would greatly benefit these patients by decreasing patient stress, reducing time to diagnosis, and increasing nursing home capabilities. This study reports on the incorporation of echogenic microspheres into catheters to produce bulk echogenic effects for developments in the field of real-time ultrasound tracking of polymeric medical devices. The impact on elastic modulus, ultrasound contrast, and cytocompatibility of the polymer was analyzed when incorporating up to 10 wt % glass microspheres. Up to this loading level, the elastic modulus was found to remain constant. However, at 10 wt %, extrusion defects due to agglomeration, air bubbles, and shearing were numerous and deemed detrimental to ultrasound imaging. Successful, defect-free samples were produced with 5 wt % microsphere loading and when embedded in a soft tissue phantom revealed a significant increase in the signal-to-noise ratio as compared to the polymer alone. Preliminary results have shown a successful increase in polymer's echogenic properties, without undermining its mechanical and cytocompatibility properties.
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Affiliation(s)
- Jerry Contreras
- Materials Science and Engineering, Virginia Tech, 400 Stanger Street, 109A Surge Bldg, MC0237, Blacksburg, Virginia 24061, United States
| | - Amy Stimpson
- Faculty of Engineering, University of Nottingham, Coates Building, University Park Campus, Nottingham NG7 2RD, U.K
| | - Ifty Ahmed
- Faculty of Engineering, University of Nottingham, Coates Building, University Park Campus, Nottingham NG7 2RD, U.K
| | - Derek J Irvine
- Faculty of Engineering, University of Nottingham, Coates Building, University Park Campus, Nottingham NG7 2RD, U.K
| | - Abby R Whittington
- Materials Science and Engineering, Virginia Tech, 400 Stanger Street, 109A Surge Bldg, MC0237, Blacksburg, Virginia 24061, United States.,Chemical Engineering, Virginia Tech, 635 Prices Fork Road, 255 Goodwin Hall MC0211, Blacksburg, Virginia 24061, United States
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7
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Liu X, Tao X, Xu Y, Zhang X, Chen Y, Wu L. Comparison of bedside ultrasonography and bedside chest radiography in neonatal peripherally inserted central catheters: A before and after self-control study. Front Pediatr 2022; 10:976826. [PMID: 36330366 PMCID: PMC9623023 DOI: 10.3389/fped.2022.976826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to compare the applications of bedside ultrasonography (US) and bedside chest radiography (CR) in positioning peripherally inserted central venous catheter (PICC) at Neonatal Intensive Care Units (NICUs). METHODS The study is a prospective before and after self-control clinical trial. A consecutive series of 181 neonate patients were finally enrolled for PICC placement. CR, followed by US, was used to evaluate and readjust the sites of catheter tips. The imaging capability for PICC key structures, fluctuation of the measured data, measurement of tip-to-atrium distance, operation time, infants' body temperature changes, and direct expenses of the two imaging modalities were obtained and compared. RESULTS (1) Comparison in viewing PICC key structures: the display rate of catheter tip, SVC-and-right-atrium junction, IVC-and-right-atrium junction and tip-to-atrium distance is 99.47%, 100%, 100% and 99.47% for US and 100%, 98.42%, 97.37% and 95.79% for CR, respectively. (2) Fluctuation of the measured data by US and CR: the tip-to-atrium distance measured by US is 0.631 (0.435-0.820) cm, and that measured by CR is 0.593 (0.210-0.825) cm. US showed a narrower range of datum variance. (3) Consistency between US and CR: for consistency analysis, the Kappa coefficient (κ) was 0.843 (P < 0.05), showing their favorable consistency. (4) Comparison of operation time and infants' body temperature drop: for a CR exam, the time period taken was significantly longer than that of US (59.7 ± 26.33 vs. 79.6 ± 28.06, P < 0.001); and CR operations caused a significant babies' body temperature drop compared to US (0.14 ± 0.11 vs. 0.34 ± 0.19, P < 0.001). (5) Comparison of the direct expenses: the total cost for CR positioning was significantly higher than that for US (¥153.99 vs. ¥143, P = 0.026). CONCLUSION US exhibited superior traits to CR in the positioning of PICC tip. It could be promising for routine use in NICU.
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Affiliation(s)
- Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ye Xu
- Radiology Department, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
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8
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Liu X, Tao X, Xu Y, Zhang X, Wu L. A Survey of the Practice Status Quo of Ultrasound-Guided ECC Tip Location for Neonatal Patients in 31 Provinces of China. Front Pediatr 2022; 10:879920. [PMID: 35911844 PMCID: PMC9329807 DOI: 10.3389/fped.2022.879920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the status quo of implementing ultrasound (US)-guided epicutaneo-caval catheters (ECC) tip location for neonatal patients in 31 provinces. METHODS The convenience sampling method was used to investigate the nursing managers and ECC (or intravenous therapy) nurses of 91 hospitals in 31 provinces from October 29 to November 10, 2021. RESULTS The survey involved a total of 182 medical staff, including 91 managers and 91 nurses, and 91 institutions, including 22 children's hospitals, 49 general hospitals and 21 maternal and child health care hospitals. Sixteen hospitals (17.6%) carried out US-guided ECC for neonatal patients; 176 subjects (96.7%) of the 91 hospitals had known about or heard of the technology of US-guided ECC. The low awareness of operators of the tip location of ECC catheters in children under ultrasound guidance (OR = 2.690, 95% CI = 1.163-6.221), limited conditions in existing wards (OR = 2.953, 95% CI = 1.285-6.790), and insufficient funds (OR = 2.836, 95% CI = 1.149-7.004) were the independent risk factors responsible for the failure to carry out ultrasonic-guided location of ECC tips in newborns. CONCLUSION The popularity of neonatal US-guided ECC location was seriously hindered by factors such as a low awareness rate of the project, the low qualification certification rate of the nursing staff, a flawed performance allocation system, and the lack of a professional team, among other factors.
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Affiliation(s)
- Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ye Xu
- Radiology Department, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
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9
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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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10
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Del Vecchio A, Salerno S, Barbagallo M, Chirico G, Campoleoni M, Cannatà V, Genovese E, Granata C, Magistrelli A, Tomà P. Italian inter-society expert panel position on radiological exposure in Neonatal Intensive Care Units. Ital J Pediatr 2020; 46:159. [PMID: 33109231 PMCID: PMC7592562 DOI: 10.1186/s13052-020-00905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the recent years, clinical progress and better medical assistance for pregnant women, together with the introduction of new complex technologies, has improved the survival of preterm infants. However, this result requires frequent radiological investigations mostly represented by thoracic and abdominal radiographs in incubators. This document was elaborated by an expert panel Italian inter-society working group (Radiologists, Paediatricians, Medical Physicists) with the aim to assist healthcare practitioners in taking choices involving radiation exposures of new-born infants and to provide practical recommendations about justification and optimization in Neonatal Intensive Care Units. The adherence to these practice recommendations could ensure a high quality and patient safety. More complex and less common radiological practice, such as CT scan or fluoroscopy have been excluded. METHODS The consensus was reached starting from current good practice evidence shared by four scientific societies panel: AIFM (Italian Association of Physics in Medicine), SIN (Italian Neonatology Society), SIP (Italian Paediatric Society), SIRM (Italian Medical Radiology Society) in order to guarantee good standard practices for every professional involved in Neonatal Intensive Care Units (NICU). The report is divided into clinical and physical-dosimetric sections: clinical Indications, good practice in radiological exposures, devices, exposure parameters and modalities, patient positioning and immobilization, Reference Diagnostic Levels, operators and patient's radiation protection. Another important topic was the evaluation of the different incubators in order to understand if the consequences of the technological evolution have had an impact on the increase of the dose to the small patients, and how to choose the best device in terms of radiation protection. At the end the working group faced the problem of setting up the correct communication between clinicians and parents following the most recent indications of the international paediatric societies. RESULTS Taking into account the experience and expertise of 10 Italian Centres, the guideline sets out the criteria to ensure a high standard of neonatal care in NICU about procedures, facilities, recommended equipment, quality assurance, radiation protection measures for children and staff members and communication on radiation risk. CONCLUSIONS This document will allow a standardization of the approach to the exposures in NICU, although oriented to a flexible methodology.
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Affiliation(s)
- Antonella Del Vecchio
- Associazione Italiana di Fisica Medica (AIFM), Milan, Italy.
- Servizio di Fisica Sanitaria, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.
| | - Sergio Salerno
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
| | | | | | | | | | | | - Claudio Granata
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
| | - Andrea Magistrelli
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
| | - Paolo Tomà
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
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11
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Alallah J, Alkubaidi N. Case 2: Unusual Cause of Abdominal Distention and Abdominal Wall Erythema in a Preterm Infant. Neoreviews 2020; 21:e619-e621. [PMID: 32873656 DOI: 10.1542/neo.21-9-e619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jubara Alallah
- Neonatology Section, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Nawal Alkubaidi
- Neonatology Section, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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12
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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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13
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Motz P, Arnim AVSAV, Likes M, Chabra S, Traudt C, Iyer RS, Dighe M. Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1341-1347. [PMID: 30244492 DOI: 10.1002/jum.14816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess whether a limited ultrasound (US) scanning protocol to monitor the upper extremity peripherally inserted central catheter (PICC) location in neonates is feasible for experienced US operators. METHODS A radiologist, who was blinded to the PICC location on chest radiography, performed 14 US scans on 11 neonates with upper extremity PICCs. A US machine with 13-6-MHz linear and 8-4-MHz phased array transducers was used for the examinations. RESULTS The study population included 54% (n = 6) preterm infants, with 72% (n = 8) weighing less than 1500 g. The US location of the PICC was the same as the chest radiographic report in all 14 scans. A subclavicular long-axis view of the anterior chest visualized all PICCs in the subclavian or brachiocephalic veins. A parasternal long-axis right ventricular inflow view was able to visualize PICCs in the superior vena cava (SVC), and a subcostal long-axis view evaluated PICCs in the lower SVC and heart. The scanning time was location dependent: less than 5 minutes for PICCs in the brachiocephalic or subclavian vein and 5 to 10 minutes for PICCs in the SVC or heart. There were no desaturations below 90%, increases in the fraction of inspired oxygen need, or hypotension episodes during scanning. CONCLUSIONS A limited US scanning protocol to determine the upper extremity PICC location is feasible. Our protocol needs to be tested in neonatal providers before further dissemination.
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Affiliation(s)
- Patrick Motz
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | | | | | - Shilpi Chabra
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | - Christopher Traudt
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | - Ramesh S Iyer
- Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Manjiri Dighe
- Radiology, University of Washington, Seattle, Washington, USA
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14
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Back to Fundamentals: Radiographic Evaluation of Thoracic Lines and Tubes in Children. AJR Am J Roentgenol 2019; 212:988-996. [PMID: 30779658 DOI: 10.2214/ajr.18.20704] [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: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to provide an up-to-date review of the radiographic appearance of the most commonly used thoracic lines and tubes in pediatric patients in daily clinical practice. CONCLUSION. Thoracic support lines and tubes are frequently used in children receiving hospital care. Evaluation of these devices is a fundamental skill in radiology. Many different devices are currently used, and new devices are regularly introduced. It is essential for radiologists to maintain a clear understanding of all devices currently in use.
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15
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O'Malley C, Sriram S, White M, Polinski C, Seng C, Schreiber MD. Feasibility and Outcomes Associated With the Use of 2.6-Fr Double-Lumen PICCs in Neonates. Adv Neonatal Care 2019; 19:E3-E8. [PMID: 30339553 DOI: 10.1097/anc.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low birth-weight infants' survival continues to improve and there is increased need to provide secure vascular access. This study examines safety of larger peripherally inserted central catheters (PICCs) that offer greater utility. PURPOSE To determine feasibility of 2.6-French (Fr) double-lumen PICCs in newborns and compare noninfectious complications such as thrombus formation, catheter breakage, infiltration, and accidental dislodgment and central line-associated bloodstream infection (CLABSI) rate with that of newborn infants treated with 1.9-Fr single- and double-lumen PICCs. METHODS Infants requiring PICCs were admitted in our 69-bed level IV neonatal intensive care unit from September 2006 to May 2015. Two distinct groups were compared: the 1.9-Fr-(single-lumen [n = 105] and double-lumen [n = 27])-and 2.6-Fr double-lumen PICCs (n = 111). Data obtained included birth weight and weight at insertion, gestational age at birth and corrected gestation age at insertion, indication, catheter days, indication for removal, and complications: noninfectious and infectious. Univariate and multivariate statistical analysis evaluated data. RESULTS There were no differences regarding gestational age at birth and insertion and indications for placement of 2.6-Fr double-lumen (n =111) and 1.9-Fr both single- and double-lumen (n = 132) PICCs. The same was noted between the groups' complications. Noninfectious complications were more common in PICCs with peripheral tip location in all groups. IMPLICATIONS FOR PRACTICE Consider use of 2.6-Fr PICCs in a neonatal intensive care unit when the utility of blood administration and sampling is required. IMPLICATIONS FOR RESEARCH Examine line migration and CLABSI associated with sampling and blood administration.
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16
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Hammon RA, Seuss H, Hammon M, Grillhösl C, Heiss R, Zeilinger M, Bayerl N, Vuylsteke P, Wanninger F, Schroth M, Uder M, Rompel O. Improved visualization of peripherally inserted central catheters on chest radiographs of neonates using fractional multiscale image processing. BMC Med Imaging 2019; 19:3. [PMID: 30612560 PMCID: PMC6322299 DOI: 10.1186/s12880-018-0302-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) provide secure intravenous access for the delivery of life-sustaining medications and nutrition. They are commonly used in pediatrics. Confirmation of correct central catheter tip position is crucial. Verification is usually done by a radiograph. The aim of this study is to evaluate the ability of Fractional Multiscale image Processing (FMP) to detect PICC tips on the digital chest radiographs of neonates. METHODS A total of 94 radiographs of 47 patients were included in the study. 29 patients were male, 18 were female. The mean age of all examined children was 9.2 days (range 0-99 days). In total, six readers (two radiologists, two residents in radiology, one last year medical student, one neonatologist) evaluated 94 unprocessed and catheter-enhanced radiographs using a 5-point Likert scale (1 = poor catheter tip visualization, 5 = excellent catheter tip visualization). Additionally, the two radiologists evaluated the diagnostic confidence for chest pathologies using a 5-point Likert scale (1 = poor diagnostic confidence, 5 = excellent diagnostic confidence). Radiographs were evaluated on a dedicated workstation. RESULTS In all cases, the catheter-enhanced radiograph rated higher than (n = 471), or equal (n = 93) to, the unprocessed radiograph when visualizing catheter tips. 87% of the catheter-enhanced radiographs obtained a rating of 4 or higher, while only 42% of unprocessed radiographs received 4 or more points. Regarding diagnostic confidence for chest pathologies one radiologist rated two catheter-enhanced radiographs higher than the unprocessed radiographs, while all other 186 evaluations rated the catheter-enhanced radiographs equal to (n = 78) or lower than (n = 108) the unprocessed radiographs. Only 60% of the catheter-enhanced radiographs yielded a diagnostic confidence of 4 or higher, while 90% of the unprocessed images received 4 or more points. CONCLUSION Catheter-enhanced digital chest radiographs demonstrate improved visualization of low contrast PICC tips in neonates compared to unprocessed radiographs. Furthermore, they enable detection of accompanying chest pathologies. However, definitive diagnosis of chest pathologies should be made on unprocessed radiographs.
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Affiliation(s)
- Rebecca A Hammon
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Hannes Seuss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany.
| | - Christian Grillhösl
- Department of Neonatology and Pediatric Intensive Care, Cnopf Children's Hospital, Sankt-Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Martin Zeilinger
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Nadine Bayerl
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | | | | | - Michael Schroth
- Department of Neonatology and Pediatric Intensive Care, Cnopf Children's Hospital, Sankt-Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Oliver Rompel
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany
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17
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Evaluation of a Magnetic Tracking and Electrocardiogram-based Tip Confirmation System for Peripherally Inserted Central Catheters in Pediatric Patients. JOURNAL OF INFUSION NURSING 2018; 41:301-308. [DOI: 10.1097/nan.0000000000000293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Telang N, Sharma D, Pratap OT, Kandraju H, Murki S. Use of real-time ultrasound for locating tip position in neonates undergoing peripherally inserted central catheter insertion: A pilot study. Indian J Med Res 2018; 145:373-376. [PMID: 28749401 PMCID: PMC5555067 DOI: 10.4103/ijmr.ijmr_1542_14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background & objectives: Securing long-term venous access is an essential part of sick newborn care. The malposition of central line tip leads to several complications. There is a need for an easily available bedside investigating tool to diagnose these malpositions. This study was done to compare the effectiveness of real-time ultrasound (RTUS) with X-ray in identifying the peripherally inserted central catheter (PICC) line tip. Methods: This pilot observational study was conducted in a level III Neonatal Intensive Care Unit of a tertiary care hospital in India, from June 2012 to June 2013. A total of 33 PICC lines in 31 infants were included in the study. After insertion of PICC line, X-ray and RTUS were done to locate the tip of the PICC line. Results: In this study, PICC line tip could be identified by bedside RTUS in 94 per cent of line insertions. Standard X-ray identified the tip in all cases. RTUS has been shown to have good diagnostic utility in comparison with X-ray with sensitivity and specificity being 96.55 and 100 per cent, respectively. In our study, majority of malpositions were identified and manipulated by RTUS, thus second X-rays were avoided. Interpretation & conclusions: The result of this pilot study shows that RTUS may be a reliable and safe bedside tool for determining the tip of PICC lines. However, studies with large sample size need to be done to confirm these findings.
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Affiliation(s)
- Nagsen Telang
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | | | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
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19
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Crealey MR, Bowden L, Ludusan E, Pathan M, Kenny B, Hannigan A, Philip RK. Utilization of conventional radiography in a regional neonatal intensive care unit in Ireland. J Matern Fetal Neonatal Med 2018; 32:2667-2673. [PMID: 29478349 DOI: 10.1080/14767058.2018.1445713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To audit the demand and radiation exposure of conventional radiography in a regional neonatal intensive care unit (NICU) in Ireland. METHODS A retrospective study of radiographs performed on all admissions to the NICU in University Maternity Hospital Limerick (UMHL) over 2 years. RESULTS A total of 1405 radiographs were performed on 506 infants. 153.5 radiographs per 1000 live births was the observed demand and 44% of radiographs were done out of hours. 47% of all radiographs were performed on infants <1500 g. Median number of radiographs per infant was one (IQR 1-2; range 1-39). Significant negative correlation was observed between number of radiographs and gestational age. Mean lung radiation doses estimated using published values for normal weight (>2500 g), very low birth weight (VLBW), and extremely low birth weight (ELBW) infants based on the median number of chest X-rays were 31.7 µGym, 84.66 and 232.75 µGy, respectively. CONCLUSIONS Conventional radiography remains a key diagnostic tool in neonatology particularly in VLBW and ELBW infants and is invaluable in supporting timely clinical decision making. Clinicians should be aware of the cost and potential hazards of neonatal radiography and is recommend that the cumulative radiation exposure among the ELBW and VLBW infants is monitored. Increasing awareness and standardisation of point-of-care ultrasonography could decrease the reliance on conventional radiography in neonatal units.
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Affiliation(s)
- Miranda R Crealey
- a Division of Neonatology, Department of Paediatrics , University Maternity Hospital Limerick (UMHL) , Limerick , Ireland
| | - Louise Bowden
- b Department of Medical Physics and Bioengineering , St. James's Hospital , Dublin , Ireland
| | - Evodia Ludusan
- a Division of Neonatology, Department of Paediatrics , University Maternity Hospital Limerick (UMHL) , Limerick , Ireland
| | - Muhammad Pathan
- a Division of Neonatology, Department of Paediatrics , University Maternity Hospital Limerick (UMHL) , Limerick , Ireland
| | - Brian Kenny
- c Department of Radiology , University Hospital Limerick (UHL) , Limerick , Ireland
| | - Ailish Hannigan
- d Graduate Entry Medical School (GEMS), University of Limerick , Limerick , Ireland
| | - Roy K Philip
- a Division of Neonatology, Department of Paediatrics , University Maternity Hospital Limerick (UMHL) , Limerick , Ireland
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20
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Cephalad dislocation of PICCs under different upper limb positions: influence of age, gender, BMI, number of lumens. J Vasc Access 2018; 19:141-145. [PMID: 29148004 DOI: 10.5301/jva.5000809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate parameters that influence the amount of movement of peripherally inserted central catheter (PICC) tips regarding upper limb movement. METHODS In a prospective 12-month observational study, 200 PICCs were implanted in 162 patients (mean age 56.8 ± 15.2 years) by interventional radiologists into the basilic vein of the mid-aspect of the upper arm. Three PICC tip positions were documented with a chest x-ray: patient supine with an abducted (90°), an adducted arm, and in an upright position with an adducted arm. Multivariable analyses were performed, based on the three positions: body mass index (BMI), number of lumens, age, gender, side of the implantation, and brand. RESULTS Up to 88% of the PICCs dislocated in a mean of 19 mm cephalad when the patient was positioned from a supine in an upright position. The greatest influence upon dislocation was the position change from supine to upright. The side of the implanted PICC (left vs. right) had no influence. CONCLUSIONS Cephalad dislocations of mean 19 mm regularly occur in the upright position induced by gravity. This needs to be taken in account and the PICC should be safely positioned one vertebra lower in the superior vena cava superior with a last confirmation of the PICC placement in an upright position.
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21
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Sancak S, Tuten A, Yildirim TG, Karatekin G. Massive pleural effusion on the contralateral side of a venous peripherally inserted central catheter. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:140-144. [PMID: 28440869 DOI: 10.1002/jcu.22493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
A preterm newborn infant, delivered at 30 weeks of gestation and 965 g birth weight, developed respiratory distress with resistant hypoxia after a central catheter line was inserted via the right venae brachialis on postnatal day 21. Left-sided massive pleural effusion, collapsed left lung with air bronchograms, and bidirectional shunting through reopened ductus arteriosus were detected by targeted neonatal echocardiography. Hydrothorax was drained under sonographic guidance, producing a milky-white fluid biochemically compatible with parenteral nutrition. We report this case of hydrothorax secondary to a misplaced central catheter on the contralateral side of its peripheral insertion. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:140-144, 2018.
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Affiliation(s)
- Selim Sancak
- Izzet Baysal Government Hospital, Neonatal Intensive Care Unit, Sağlık mahallesi, Şehitler caddesi, Merkez/Bolu, 14300, Türkiye, Bolu, Turkey
| | - Abdulhamit Tuten
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
| | - Tulin Gokmen Yildirim
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
| | - Guner Karatekin
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
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22
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Ramamurthi A, Chick JFB, Srinivasa RN, Hage AN, Grove JJ, Gemmete JJ, Johnson TD, Srinivasa RN. Chest Radiograph Measurement Technique Facilitates Accurate Bedside Peripherally Inserted Central Catheter Placement in Children. Cardiovasc Intervent Radiol 2017; 41:443-448. [PMID: 29238870 DOI: 10.1007/s00270-017-1857-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the chest radiograph measurement technique for placing bedside peripherally inserted central catheters (PICCs). MATERIALS AND METHODS Two hundred and thirty-two consecutive pediatric patients, mean age of 56.3 months (range: 0-203 months), underwent PICC placement from January 2015 to May 2017 (28 months) with a total of 232 PICCs placed. Measurements were taken from the cavoatrial junction to clavicle, clavicle to medial margin of mid-humeral head, and medial margin of mid-humeral head to mid-humerus. The difference between total radiographic measured length and actual PICC length was then calculated, and the percent difference (from actual cut length) was recorded. An equivalence test was performed using the two, one-sided test method. RESULTS Mean ± standard deviation cavoatrial junction to clavicle length was 5.29 ± 2.20 cm (range: 2.1-12.6 cm). Mean clavicle to shoulder length was 8.20 ± 3.59 cm (range: 3.23-19.06 cm). Mean shoulder to mid-humerus length was 7.88 ± 3.87 cm (range: 2.01-16.8 cm). Mean total radiographic measured length was 21.37 ± 9.19 cm (range: 7.42-43.6 cm). Mean actual cut PICC length was 20.64 ± 8.72 cm (range: 8.5-44 cm). The mean difference between predicted, or total radiographic measured length, and actual cut PICC length was 0.73 ± 2.51 (range: - 5.42-8.60 cm). The mean percent difference was 4.07 ± 12.65% (range: - 23.84-47.80%). An equivalence test rejected the null hypothesis of the true percent difference greater/less than ± 6.67% with a p value of 0.002. CONCLUSION The chest radiograph measurement technique is an accurate method to determine catheter length for PICC placement at bedside in the pediatric population.
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Affiliation(s)
- Aishu Ramamurthi
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.,Department of Biology, Duke University, Durham, NC, 27705, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Rajiv N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jason J Grove
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Timothy D Johnson
- Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arobr, MI, 48109, USA
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Garg M, Rajan N, Dhua A, Krishnan L. Malpositioned Central Line in A Neonate Presenting as Superficial Abdominal Abscess. J Neonatal Surg 2017; 6:24. [PMID: 28083510 PMCID: PMC5224758 DOI: 10.21699/jns.v6i1.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/21/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Manasi Garg
- Department of Pediatrics, Pondicherry Institute of Medical Sciences
| | - Nishanth Rajan
- Department of Pediatrics, Pondicherry Institute of Medical Sciences
| | - Anjan Dhua
- Department of Pediatric Surgery, Pondicherry Institute of Medical Sciences
| | - Lalitha Krishnan
- Department of Pediatrics, Pondicherry Institute of Medical Sciences
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24
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Merchaoui Z, Lausten-Thomsen U, Pierre F, Ben Laiba M, Le Saché N, Tissieres P. Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates. Front Pediatr 2017; 5:211. [PMID: 29051889 PMCID: PMC5633682 DOI: 10.3389/fped.2017.00211] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022] Open
Abstract
The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates. More than 1,250 catheters have been reported inserted in children and neonates for a cumulated success rate of 98.4% and the complication rate is reported to be low. The technical aspects of various approaches are discussed, and we offer our recommendation of an US-guided technique for SCV and BCV cannulation based on our experience in a large NICU setting. Although the cannulation the SCV or BCV does not substitute the use of peripherally inserted central catheters or umbilical venous central catheters in neonates, it is a feasible route in very small children who are in need of a large caliber central venous access.
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Affiliation(s)
- Zied Merchaoui
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Ulrik Lausten-Thomsen
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell, CNRS, CEA, University of Paris Sud, Paris Saclay University, Gif-sur-Yvette, France
| | - Florence Pierre
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Maher Ben Laiba
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nolwenn Le Saché
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Tissieres
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell, CNRS, CEA, University of Paris Sud, Paris Saclay University, Gif-sur-Yvette, France
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Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. Catheter tip position and risk of mechanical complications in a neonatal unit. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Saul D, Ajayi S, Schutzman DL, Horrow MM. Sonography for Complete Evaluation of Neonatal Intensive Care Unit Central Support Devices: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1465-1473. [PMID: 27229130 DOI: 10.7863/ultra.15.06104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Neonates in the neonatal intensive care unit often require considerable support with endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. Support device evaluation with radiography exposes neonates to ionizing radiation. This study evaluated the effectiveness of sonographic localization for endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. METHODS This blinded prospective Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study with informed consent compared sonography to radiography for endotracheal tube, umbilical arterial and venous catheter, and peripherally inserted central venous catheter localization. Participants were consecutively recruited NICU patients of any weight, gestation, and chronologic age who had an endotracheal tube, umbilical arterial catheter, umbilical venous catheter, or peripherally inserted central venous catheter placed or adjusted and had subsequent radiographic confirmation within 24 hours. Sonographic evaluation was obtained as soon as possible, without prior review of the radiograph, and results were compared. RESULTS Thirty sonographic studies were performed in 25 patients (14 male and 11 female), for a total of 50 lines and tubes: 18 umbilical venous catheters, 12 umbilical arterial catheters, 11 peripherally inserted central venous catheters, and 9 endotracheal tubes. Forty-nine support devices (98%) were visualized with sonography, all concordant with radiography. Forty-four were correctly positioned, and 6 were malpositioned. Sonography identified the location of umbilical venous catheters in all 18 cases (100%), umbilical arterial catheters in all 12 (100%), peripherally inserted central venous catheters in 10 (91%), and endotracheal tubes in 9 (100%). CONCLUSIONS The effectiveness of sonography was excellent for evaluation of umbilical arterial and venous catheters, endotracheal tubes, and peripherally inserted central venous catheters. These results support the goal of further point-of-care training and accreditation to use sonography as a primary modality for complete evaluation of NICU support devices.
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Affiliation(s)
- David Saul
- Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania USA
| | - Samuel Ajayi
- Department of Pediatrics, Einstein Medical Center, Philadelphia, Pennsylvania USA
| | - David L Schutzman
- Department of Pediatrics, Einstein Medical Center, Philadelphia, Pennsylvania USA
| | - Mindy M Horrow
- Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania USA
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Mundi MS, Edakkanambeth Varayil J, McMahon MT, Okano A, Vallumsetla N, Bonnes SL, Andrews JC, Hurt RT. Accuracy of Intravenous Electrocardiography Confirmation of Peripherally Inserted Central Catheter for Parenteral Nutrition. Nutr Clin Pract 2016; 31:207-10. [DOI: 10.1177/0884533615621548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Manpreet S. Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Jithinraj Edakkanambeth Varayil
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Family Medicine, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
| | - Megan T. McMahon
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Akiko Okano
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nishanth Vallumsetla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara L. Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ryan T. Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Kentucky
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Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. [Catheter tip position and risk of mechanical complications in a neonatal unit]. An Pediatr (Barc) 2015; 85:77-85. [PMID: 26652241 DOI: 10.1016/j.anpedi.2015.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/08/2015] [Accepted: 10/19/2015] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The use of central catheters (CC) is associated with mechanical complications (MC). OBJECTIVE Our objetive was to determine the relationship between CC positions and associated MC in neonates. MATERIAL A descriptive analytical study was performed over a six year period in the NICU of the University Hospital Santa Lucía de Cartagena. Details were collected on the CC used, indication, reason for withdrawal, position in the imaging, MC, and treatment arising from them, as well as epidemiological data. RESULTS Of the total of 604 CC studied, the majority (347) were via the umbilical vein, followed by epicutaneous (193), and femoral vein (34). There were MC in 14.2% of catheters. Incorrect position of the tip was associated with greater MC (21.1 vs 8.2%; P<.001), including withdrawal due to MC (8.4 vs 3.1%; P<.01), extravasation (4.9 vs 1.9%; P<.05), pleural and pericardial effusions (1.4 vs 0.0%; P<.05), liver haematomas (4.6 vs 0.6%; P<.01), and ascites (2.8 vs 0.0%; P<.01). The midclavicular epicutaneous position of the tip was associated with greater MC (18.5 vs 6.8%; P<.05) than the brachiocephalic (0 vs 6.8%;NS). The low and ductal position of the umbilical vein catheter was also associated with higher rates of MC (24.5 vs 6%; P<.001 and 27 vs 6%; P<.001) due to the position of the tip. The most common complication was accidentally dislodged catheter. CONCLUSIONS The incorrect location of the tip was associated with more MC. The midclavicular epicutaneous had more risk than centrally or brachiocephalic locations. The low and ductal positions of the umbilical vein catheter were associated with higher rates of MC.
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Affiliation(s)
- Jose Maria Lloreda-García
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España.
| | - Ana Lorente-Nicolás
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Francisca Bermejo-Costa
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Jose Ramón Fernández-Fructuoso
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
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Rangel UV, Gomes Junior SCDS, Costa AMAM, Moreira MEL. Variables associated with peripherally inserted central catheter related infection in high risk newborn infants. Rev Lat Am Enfermagem 2014; 22:842-7. [PMID: 25493681 PMCID: PMC4292672 DOI: 10.1590/0104-1169.3481.2488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 07/08/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE: to relate the variables from a surveillance form for intravenous devices in high
risk newborn infants with peripherally inserted central catheter related
infection. METHODOLOGY: approximately 15 variables were studied, being associated with peripherally
inserted central catheter related infection, this being defined by blood culture
results. The variables analyzed were obtained from the surveillance forms used
with intravenous devices, attached to the medical records of newborn infants
weighing between 500 and 1,499 g. The statistical association was defined using
the Chi-squared and Student t tests. The study was approved by the Research Ethics
Committee of the Instituto Fernandes Figueira under process N. 140.703/12. RESULTS: 63 medical records were analyzed. The infection rate observed was 25.4%. Of the
variables analyzed, only three had a statistically-significant relationship with
the blood culture - the use of drugs capable of inhibiting acid secretion,
post-natal steroid use, and undertaking more than one invasive procedure (p-value
of 0.0141, 0.0472 and 0.0277, respectively). CONCLUSION: the absence of significance of the variables of the form may be related to the
quality of the records and to the absence of standardization. It is recommended
that the teams be encouraged to adhere to the protocol and fill out the form.
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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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Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 2013; 33:307-12. [PMID: 22955288 DOI: 10.1038/jp.2012.112] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To characterize the relationship between peripherally inserted central catheters (PICC) tip positions and associated complications in neonates. STUDY DESIGN Catheter tip position for 319 infants was classified into superior vena cava (SVC, n=131), inferior vena cava (IVC, n=72), brachiocephalic (BC, n=59), midclavicular (MC, n=49) or iliac. Duration of catheter stay and complication profile was compared between central (SVC/IVC) vs non-central PICC, and between SVC vs IVC, SVC vs BC and SVC vs MC. Kaplan-Meier survival analysis and regression models were used. RESULT Overall length of catheter stay was similar between central and non-central group. Non-central catheters (n=116) had higher complication rates (47 vs 29%; P=0.001), non-elective removals (45 vs 27%; P=0.002) and shorter time to complication (6.2 vs 11.4 days; P=0.043). This difference was primarily due to the complications encountered in MC group, which had the highest rate of infiltration (P<0.001) and mechanical complications while outcomes were similar among other subgroups. Interestingly, catheter survival probability was similar in all groups for first 4 days. Rate and types of blood stream infections were not related to catheter tip position. CONCLUSION Non-central PICCs are associated with higher rates of infiltration and mechanical complications when the tip is in MC region. BC catheters may have comparable outcomes to SVC in neonates. A careful risk-benefit analysis is warranted when MC catheters are used in neonates.
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Affiliation(s)
- A Jain
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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