Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates – A Prospective Diagnostic Evaluation study

Abstract

OBJECTIVE: To evaluate the diagnostic accuracy and utility of bedside ultrasound (US) by neonatology residents to confirm position of umbilical venous catheter (UVC), umbilical arterial catheter (UAC), and peripherally inserted central catheter (PICC). METHODS: In this prospective study, we included neonates who required UVC, UAC or PICC insertion. Two neonatology residents performed all bedside US examinations after a short period of training. Plain radiograph was taken as gold standard. Time taken for confirmation of catheter position by US and radiograph was recorded. RESULTS: We recruited 71 neonates for UVC and UAC, and 40 neonates for PICC. Sensitivity and specificity of US in identifying a malpositioned catheter was good for UVC (94% and 66.7% respectively) and UAC (86.7% and 94.5%). Agreement between radiograph and US was good for UVC [0.718 (0.512, 0.861); p < 0.001] and UAC [0.857 (0.682, 0.953); p < 0.001]. Sensitivity (47.8%) of US in identifying a malpositioned PICC was low, though specificity (82.4%) was good. Agreement between radiograph and US in identifying PICC position was poor [0.25 (–0.084, 0.545); p 0.024]. This was due to incorrect interpretation of catheter position on radiograph in some infants, which was confirmed by the radiologist. The median time taken for US was significantly less than time taken for radiograph in confirming the position of UVC (50 vs. 155 minutes; p < 0.001)), UAC (45 vs. 128 minutes; p < 0.001), and PICC (60 vs. 136 minutes; p < 0.001). CONCLUSION: US examination byneonatology residents has good diagnostic accuracy in confirming the position of UAC and UVC, and possibly PICC in neonates. The time taken to confirm catheter position by US is significantly less than radiograph.

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

“…Anatomical survey with transverse, sagittal and cine images of trachea, thymus, lungs and pleura, great vessels, aortic arch, heart. Dedicated transverse and sagittal views of the tip and shaft of the PICC Neonatology resident with 4 years’ experience in US or attending radiologist with subspecialisation in sonography (~ 30 years) Shabeer et al [ 40 ] 13-MHz linear probe. Right parasternal axis and subcostal views 2 neonatology residents with 18 months of neonatal training and who perform regular US examinations of the brain and heart Telang et al [ 37 ] 5–12 MHz sector probe.…”

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

“…The low specificity can be explained by referencing the studies by Jain et al [ 39 ] and Shabeer et al [ 40 ]. Jain et al [ 39 ] reported sensitivity and specificity values of 60% (95% CI 41.6–81.1) and 58% (95% 34.1–73.5%), respectively.…”

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

“…Similarly, ultrasound performed by neonatal residents and neonatal nurse practitioners has good results in terms of diagnostic accuracy, after adequate training ( 49 , 50 ).…”

The role of ultrasonography for detecting tip location of percutaneous central venous catheters in neonates—a single-center, prospective cohort study

“…7 Aside from PCVCs, confirming the location of the tips of other catheters, including umbilical vein and umbilical artery catheters used commonly in premature babies, was also reported. 8 However, due to the small number of cases requiring this procedure, the evidence is insufficient for supporting the use of US as the gold-standard tool for identifying the tip location of PCVCs.…”