1
|
Stekhova Y, Kodur V, Lowe G, Baird J, Lowe K, Elhindi J, Maheshwari R, Shah D, D'Cruz D, Luig M, Jani PR. Role of a radiopaque agent and surveillance radiographs for peripherally inserted central catheters in newborn infants. Pediatr Radiol 2023; 53:2235-2244. [PMID: 37490126 PMCID: PMC10562302 DOI: 10.1007/s00247-023-05705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Controversy exists regarding the use of a radiopaque agent to identify peripherally inserted central catheter (PICC) tip positions in newborn infants and of serial radiography to monitor PICC tip migration. OBJECTIVE To investigate the roles of (1) the injection of a radiopaque agent to identify PICC tip position and (2) the performance of weekly radiography to monitor PICC migration. MATERIALS AND METHODS This retrospective single-centre cohort study included newborn infants who received a PICC between 1 January 2016 and 31 December 2020. A radiopaque agent was injected to identify PICC tip position and radiographs were performed weekly to detect PICC migration. RESULTS We identified 676 PICC episodes in 601 infants. A radiopaque agent was used for 590 of these episodes. There was no difference in the proportion of central PICC tip positions based on radiopaque agent use status (490/590, 83% for the radiopaque agent used group versus 73/85, 85.8% for the radiopaque agent not used group, P=0.51). Irrespective of the site of PICC insertion, outward migration was observed for most centrally placed PICCs over their entire in situ duration. Inward migration was identified in 23 out of 643 PICC episodes (3.6%) only on radiographs obtained on or before day 7. Based on serial radiographs, the odds for PICC tips remaining in a central position were lower the longer the PICC remained in situ (adjusted odds ratio-OR 0.93; 95% confidence interval 0.92-0.95). There was no difference in PICC migration between side and limb of insertion. CONCLUSION PICC tips can be identified without injection of a radiopaque agent. Serial radiographs identified PICC migration over the in situ duration. This study has implications for reducing exposure to a radiopaque agent and ongoing migration surveillance practices.
Collapse
Affiliation(s)
- Yulia Stekhova
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Vinayak Kodur
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Gemma Lowe
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Jane Baird
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - James Elhindi
- Research and Education Network, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rajesh Maheshwari
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dharmesh Shah
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Daphne D'Cruz
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Melissa Luig
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Pranav R Jani
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
2
|
Pereira HP, Secco IL, Arrué AM, Pontes L, Danski MTR. Implementation of modified Seldinger technology for percutaneous catheterization in critically ill newborns. Rev Esc Enferm USP 2023; 57:e20220347. [PMID: 37402230 DOI: 10.1590/1980-220x-reeusp-2022-0347en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE To describe the implementation of Modified Seldinger Technology for percutaneous catheterization in critically ill newborns. METHOD A quasi-experimental before- and-after study, carried out with neonatologist nurses in a Neonatal Intensive Care Unit. RESULTS Seven nurses participated in the research. Catheter pre-insertion, insertion and maintenance were assessed using the conventional and modified Seldinger technique. Reliability was satisfactory in pre-test, 5.40 (Md = 6.00), and post-test, 5.94 (Md = 7.00), and perfect in the items about device insertion and maintenance. There was low assertiveness in the items on indication, microintroduction procedure via ultrasound, limb repositioning and disinfection of connections/connectors. CONCLUSION Despite the Modified Seldinger Technique expanding some stages of execution over the traditional method of percutaneous catheterization, nurses were more assertive after theoretical-practical training. The technology was implemented and is in the process of being implemented in the health service.
Collapse
Affiliation(s)
- Higor Pacheco Pereira
- Universidade Federal do Paraná, Hospital Infantil Waldemar Monastier, Campo Largo, PR, Brazil
| | - Izabela Linha Secco
- Universidade Federal do Paraná, Hospital Infantil Waldemar Monastier, Campo Largo, PR, Brazil
| | | | - Letícia Pontes
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brazil
| | | |
Collapse
|
3
|
Rossi S, Jogeesvaran KH, Matu E, Khan H, Grande E, Meau-Petit V. Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy. Eur J Pediatr 2022; 181:2097-2108. [PMID: 35152306 DOI: 10.1007/s00431-022-04412-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 01/22/2023]
Abstract
UNLABELLED Objective of the study was to compare number of X-rays performed for neonatal central line tip positioning when real-time US is used compared to X-ray only, and to assess consequences on position accuracy, irradiation and cost. Retrospective monocentric cohort study conducted at Evelina London Children's Hospital Neonatal Unit over 6 months. Study was conducted during implementation of US for line tip localisation with formulation of US protocol. Tip position on X-ray was reviewed by one neonatologist and one radiologist and inter-rater agreement calculated. Criteria for good, satisfactory or inadequate position of the tip were defined. Estimated effective radiation dose and cost for each X-ray was determined. Two hundred seventy-four lines were inserted (nPICC, UVC, UAC). Eighty-three lines were scanned with US (US group); 191 lines were not (no-US group). Number of X-rays performed was significantly lower in the US group: 1.19 vs. 1.5 (p 0.001), related to a significantly lower percentage of lines requiring multiple X-rays (38.7% no-US group vs. 19.9% US group; p 0.004). Accuracy was higher in US group with more lines at cavoatrial junction (p 0.05) and was significantly increased with US use for lines inserted from lower limbs (22.9% and 76.2%, p 0.001). Inter-rater agreement was strong (k > 0.8). US group received lower mean radiation dose (p < 0.001) and cost related to X-ray was significantly reduced (p 0.001). CONCLUSION Real-time US use for line tip positioning in the NICU significantly decreased the number of X-rays performed and was associated with better-positioned lines, decreased irradiation and cost. WHAT IS KNOWN • The use of point-of-care ultrasound (PoCUS) by critical care providers in neonatology has increased in recent years. International guidelines advocate for the use of PoCUS as valid guidance to practical procedures in neonatology. • Central catheters (umbilical catheters and neonatal peripherally inserted central catheters) are among the most commonly used devices to support NICU patients. Proper positioning is crucial to avoid complications and PoCUS has high sensitivity and specificity in accurately determining line tip position. The current standard practice for line tip position confirmation in neonatology is still conventional radiography despite multiple evidence suggest significant inaccuracy of X-ray compared to ultrasound. WHAT IS NEW • PoCUS implementation for line tip positioning leads to a significant decrease in the number of X-rays performed, in radiation effective dose and costs. PoCUS evaluation of central catheters significantly increases the accuracy of the final line tip position with more lines at the cavoatrial junction. • Training is fundamental for univocal interpretation of ultrasound images and an effective learning strategy is being proposed.
Collapse
Affiliation(s)
- Serena Rossi
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, NHS Foundation Trust, St Thomas' Hospital, Guy's and St ThomasNorth Wing 6th floor, Westminster Bridge Road, London, SE1 0EH, UK.
| | - K Haran Jogeesvaran
- Paediatric Radiology Department, Evelina London Children's Hospital, NHS Foundation Trust, St Thomas' Hospital, Guy's and St ThomasWestminster Bridge Road, London, SE1 0EH, UK
| | - Eugen Matu
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, NHS Foundation Trust, St Thomas' Hospital, Guy's and St ThomasNorth Wing 6th floor, Westminster Bridge Road, London, SE1 0EH, UK
| | - Hammad Khan
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, NHS Foundation Trust, St Thomas' Hospital, Guy's and St ThomasNorth Wing 6th floor, Westminster Bridge Road, London, SE1 0EH, UK
| | - Elisabetta Grande
- Department of Paediatrics and Neonatology, Ospedale della Misericordia, Grosseto, Italy
| | - Virginie Meau-Petit
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, NHS Foundation Trust, St Thomas' Hospital, Guy's and St ThomasNorth Wing 6th floor, Westminster Bridge Road, London, SE1 0EH, UK
| |
Collapse
|
4
|
Benn KL, Shetty S, Masna AM, Kulkarni AM. Unintentional longline insertion into the descending aorta in a neonate with left congenital diaphragmatic hernia. Arch Dis Child Fetal Neonatal Ed 2021; 106:430. [PMID: 32669359 DOI: 10.1136/archdischild-2020-319293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Kerri L Benn
- Neonatal Intensive Care Centre, Saint George's Hospital NHS Foundation Trust, London, UK
| | - Sandeep Shetty
- Neonatal Intensive Care Centre, Saint George's Hospital NHS Foundation Trust, London, UK
| | - Anne Marie Masna
- Neonatal Intensive Care Centre, Saint George's Hospital NHS Foundation Trust, London, UK
| | - Anay M Kulkarni
- Neonatal Intensive Care Centre, Saint George's Hospital NHS Foundation Trust, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Pettinger KJ, Wordie AIC, Vas CJ, Hattingh L, Vasudevan C. Long lines and atypical anatomy. Arch Dis Child Educ Pract Ed 2020; 105:364-366. [PMID: 30948481 DOI: 10.1136/archdischild-2018-316612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Chris J Vas
- Neonatal Unit, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Louise Hattingh
- Department of Radiology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | | |
Collapse
|