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

Abstract

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 evidenc 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.

Práticas do enfermeiro no cateterismo epicutâneo guiado por ultrassonografia em neonatos: scoping review

“…A amostra evidenciou que publicações com a temática abordada são em pequeno número. Neste estudo, dezessete publicações foram incluídas para revisão, sendo doze (70,6%) da PubMed (BARONE et al, 2022;BAYOUMI et al, 2022;FRIDOLFSSON, 2022;GRASSO et al, 2022;ROSSI et al, 2022;TU et al, 2021;SUELL et al, 2020;MOTZ et al, 2019a;MOTZ et al, 2019b;JOHNSON et al, 2016;NGUYEN, 2016;ABDEYAZDAN et al,2014) e dois (11,7%) da EMBASE (CASTRO et al, 2014;KADIVAR et al, 2020). LILACS (VILAR et al,2020), WOS (SINGH et al, 2020), BDTD (NEGRI, 2019) contribuíram com um (5,9%) estudo cada.…”

“…produções (BARONE et al, 2022;BAYOUMI et al, 2022;FRIDOLFSSON, 2022;GRASSO et al, 2022;ROSSI et al, 2022;TU et al, 2021;KADIVAR et al, 2020;SINGH et al, 2020;SUELL et al, 2020;VILAR et al,2020;MOTZ et al, 2019a;MOTZ et al, 2019b;NEGRI, 2019). O ano de 2016 se destacou com duas (11,8%) publicações (JOHNSON et al, 2016;NGUYEN, 2016), seguido de 2014, com duas (11,8%) (ABDEYAZDAN et al,2014;CASTRO et al, 2014).…”

“…Os médicos foram os autores responsáveis por treze (76,5%) publicações (BARONE et al, 2022;BAYOUMI et al, 2022;GRASSO et al, 2022;ROSSI et al, 2022;TU et al, 2021;KADIVAR et al, 2020;SINGH et al, 2020;SUELL et al, 2020;MOTZ et al, 2019a;MOTZ et al, 2019b;JOHNSON et al, 2016;NGUYEN, 2016;CASTRO et al, 2014) seguidos pelos enfermeiros, com quatro (23,5%) publicações (FRIDOLFSSON, 2022;VILAR et al,2020;NEGRI, 2019;ABDEYAZDAN et al,2014).…”

Ultrasound to guided epicutaneo-caval catheter insertion in newborn infants

“…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).…”