Sonography for Complete Evaluation of Neonatal Intensive Care Unit Central Support Devices

Saul, David; Ajayi, Samuel; Schutzman, David L.; Horrow, Mindy M.

doi:10.7863/ultra.15.06104

Cited by 49 publications

(70 citation statements)

References 27 publications

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“…4 Saul et al described their experience using US for ETT, umbilical line, and peripherally inserted central line positions with a mean scan time of 7 minutes and less, and with > 90% successful identification rates for all examinations. 18 The benefits of US in regard to minimal patient manipulation and lack of radiation exposure warrants further investigation even if the time needed for the examination is ultimately similar to XR.…”

Section: Discussionmentioning

confidence: 99%

“…12 Saul et al accomplished a mean US scan time of 7 minutes but did not report XR time for comparison. 18 Alonso Quintela et al compared US to capnography and XR for ETT positioning in their NICU and pediatric ICU. 13 The authors found no significant differences between US and capnography in detecting endotracheal versus esophageal intubation in neonates; however, US was significantly slower than capnography, 34 versus 7 seconds, respectively.…”

Section: Ultrasound Versus Other Modalities To Determine Endotrachealmentioning

confidence: 99%

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Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

2016

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Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults and older children but has been less studied in the neonates and infants. The literature regarding US utility for ETT positioning in this population is reviewed. A literature search was conducted using the EMBASE, Google Scholar, MEDLINE, Ovid, and Scopus databases with search terms regarding US relating to ETT intubation and positioning in neonates and infants. Nine relevant studies were included for review. All studies report > 80% visualization of the ETT tip by US. US interpretation of the ETT position correlated with the radiography position in 73 to 100% of cases when the ETT tip was visible. There were variations in technique, sonographer, and sonographer training between studies. US appears to be well tolerated by neonates and infants and may augment the determination of proper ETT position. Further studies are needed regarding optimal technique and sonographer training.

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Section: Discussionmentioning

confidence: 99%

Section: Ultrasound Versus Other Modalities To Determine Endotrachealmentioning

confidence: 99%

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

2016

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“…19 An abdominal US or echocardiography is more sensitive and accurate for detecting UV catheter malposition than is radiography. 17,19 US is more precise than radiography because it allows direct visualization of the UV catheter tip in relation to internal vascular structures 9,20 The results of this study show that real-time US enables the location of the UV catheter tip to be confirmed 9,10,14 and prevents HE after UVC, supporting the conclusions of previous reports, which have affirmed that US is reliable and may replace radiography for the identification of UV catheter position, preventing complications resulting from malpositioning and reducing exposure to ionizing radiation. 16 US assessment is operator-dependent, which requires a lot of practice and clinical experience to reach the diagnostic level.…”

Section: Discussionmentioning

confidence: 99%

Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience

Chen

Chao

Chiang

et al. 2020

Pediatrics & Neonatology

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Background: Care of newborns in the neonatal intensive care unit generally involves umbilical venous catheterization (UVC) for central vein access to enable medical needs. The study aimed to evaluate the sonographic appearance, risk factors, and outcomes of UVCrelated hepatic extravasation (HE) in neonates. Methods: A 5-year retrospective study where 33 neonates were enrolled with a diagnosis age ranging from 2 to 25 days. 78.8% of the subjects had UVC malpositioning shown on initial radiography. All neonates sonographically diagnosed with HE, and follow-up ultrasound (US) was performed. Results: The main findings of HE on US were hyperechoic or heterogeneous lesions of a lobulated (51.7%) or wedge shape (48.3%), located mainly in the left lobe (72.7%). The mean time to resolution of HE was 2.25 months. Seven (21.2%) patients showed hepatic vascular thrombosis at follow-up. Two (6%) patients had abnormal liver function, which subsequently normalized. Conclusion: Malposition of the UV catheter was the predisposing factor for UVC-related HE in neonates. US facilitates detection of UVC malpositioning and diagnosis of HE, as well as delayed complications. A shorter duration of UVC placement is associated with favorable outcomes of UVC-related HE in neonates.

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“…Ultrasound sensitivity in the present evaluation was 100%, with a specificity of 89.5%, PPV of 97.3%, and NPV of 100%. Saul et al reported both the sensitivity and specificity of ultrasound as 100% (24).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

et al. 2020

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Background: Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography. Objectives: We compared the effectiveness of sonography with radiography for confirmation of the line tip placement. Methods: This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests. Results: A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%. Conclusions: Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning.

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Sonography for Complete Evaluation of Neonatal Intensive Care Unit Central Support Devices

Cited by 49 publications

References 27 publications

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience

Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU

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