Confirming longline position in neonates - Survey of practice in England and Wales

Abstract

AIMTo establish how neonatal units in England and Wales currently confirm longline tip position, immediately after insertion of a longline.METHODSWe conducted a telephone survey of 170 neonatal units (37 special care baby units, 81 local neonatal units and 52 neonatal intensive care units) across England and Wales over the period from January to May 2016. Data was collected on specifically designed proformas. We gathered information on the following: Unit Level designation; whether the unit used longlines and specific type used? Modality used to confirm longline tip position? Whether guide wires were routinely removed and contrast injected to determine longline position? The responders were primarily senior nurses.RESULTSWe had 100% response rate. Out of the total neonatal units surveyed (170) in England and Wales, 141 units (83%) used longlines. Fifty-five out of 81 local neonatal units (68%) using longlines, used ones that came with guide wires; a similar percentage of neonatal intensive care units, i.e., 31 out of 52 units (60%) did the same. All of those units used radiography, plain X-rays, to establish longline tip position. Out of 55 local neonatal units using longlines with guide wires, 42 (76%) were not removing wire to use contrast while this figure was 58% (18 out of 31 units) for neonatal intensive care units. Overall, only 49 out of 141 units (35%) of the units using longlines were using contrast. However it was interesting to note that use of contrast increased as one moved from special care baby units (25%, 2 out of 8 units) to local neonatal units (28%, 23 out of 81 units) and neonatal intensive care units level (46%, 24 out of 52 units) designation.CONCLUSIONNeonatal units in England and Wales are overwhelmingly relying on plain radiographs to assess longline tip position immediately after insertion. Despite evidence of its usefulness, and in the absence of perhaps more accurate methods of assessing longline tip position in a reliable and consistent way, e.g., ultrasonography, contrast is only used in a third of units.

Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates

“…For catheters inserted from the lower part of the body, the anatomical landmark is the xiphoid. At the end of the maneuver of ECC insertion, post-procedural tip location is usually assessed by chest X-ray 36 : the correct tip position is approximately 1 cm outside the cardiac silhouette in preterm infants and 2 cm for term infants, 37,38 as this position is believed to be related to a lower incidence of cardiac tamponade. 39 Though, chest X-ray allows only a very rough estimation of the tip location, based on relatively unreliable radiological landmarks.…”

Tecnologias para manutenção do Cateter Central de Inserção Periférica em neonatos: revisão integrativa

“…Mesmo com os avanços, a tecnologia mais frequentemente disponível nos serviços de neonatologia hospitalar para os procedimentos de verificação de posicionamento da ponta do PICC ainda é a radiografia torácica. 25 Estudo brasileiro reportou o posicionamento inicial da ponta do PICC e a prevalência de sucesso de inserção em 37 neonatos; 72,3% (27) cateteres progrediram, e 74,1% (20) destes estavam mal posicionados. Foi executada manobra de tração do cateter nos dispositivos mal posicionados, que resultou no posicionamento central de 83,3% (20) dos casos.…”

“…12,[17][18][19][20][21][22][23] A verificação da ponta do cateter é realizada por meio de ultrassonografia, eletrocardiograma e radiografia de tórax. [24][25] Os recursos que permitam acompanhar a ponta do cateter em tempo real facilitam sua inserção em posição ideal; contudo, muitos serviços de saúde não dispõem dessas tecnologias de imagem. 4 A radiografia é o método convencional de verificação do posicionamento do PICC.…”

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

“…Proper positioning of the catheter is recommended to decrease risk of complications, which can be life-threatening, such as cardiac tamponade [4,5]. The current standard for line tip positioning is conventional radiography [6,7]. X-ray is a post-procedural method which estimates the position of the line tip based on static landmarks like the cardiac silhouette or the diaphragm level [8].…”