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

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.

Ultrasound to guided epicutaneo-caval catheter insertion in newborn infants

“…In conclusion, as an intraprocedural methodology, ultrasound is believed to be the most promising tool for tip navigation and location during the placement of central venous access devices in neonates, and it is appropriate for both tip navigation and tip location ( 3 ). The present study also proved that ECC catheterization under ultrasound guidance has outstanding advantages, significantly improving the success rate of one-time catheterization and shortening the time of catheterization and significantly decreasing catheter-related complications with no radiation damage, which warrants wide application in clinical practice ( 2 , 3 , 10 , 14 ).…”

“…As mentioned above, CXR has a number of disadvantages. To overcome these shortcomings, the ultrasound localization method has been gradually applied in clinical practice in recent years (3,4,(7)(8)(9)(10)(13)(14)(15), and studies or guidelines recommending ultrasound as the "gold standard" for determining the correct tip position have been developed (2)(3)(4).…”

“…Therefore, the use of ultrasound (US) for catheter placement confirmation in the neonatal fields has been developed widely with a variety of advantages (7)(8)(9)(10). Catheterization through the great saphenous veins (GSVs) of the lower extremities is the most commonly used approach for neonatal ECC (11,12).…”

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

“…42 O USG foi utilizado para a confirmação da posição do PICC durante sua inserção, resultando em sucesso no posicionamento em mais de 90% dos casos. 27,[37][38]41,58 Ressalta-se a não exposição dos pacientes à radiação, a fácil operação e sua alta precisão. 34,38,42,58 O uso do USG em tempo real durante a punção do PICC é encorajado; a orientação em tempo real durante a inserção do dispositivo diminui a incidência de mal posicionamento do PICC em neonatos quando comparado à mensuração por marcos anatômicos, [26][27] além apresentar vantagens em termos de precisão, custo-benefício e segurança.…”

“…27,[37][38]41,58 Ressalta-se a não exposição dos pacientes à radiação, a fácil operação e sua alta precisão. 34,38,42,58 O uso do USG em tempo real durante a punção do PICC é encorajado; a orientação em tempo real durante a inserção do dispositivo diminui a incidência de mal posicionamento do PICC em neonatos quando comparado à mensuração por marcos anatômicos, [26][27] além apresentar vantagens em termos de precisão, custo-benefício e segurança. 59 O USG permitiu a detecção precisa da localização da ponta do PICC e possibilitou a observação das mudanças de posição associadas ao movimento do membro em tempo real.…”