Superiority of targeted neonatal echocardiography for umbilical venous catheter tip localization: accuracy of a clinician performance model

Pulickal, Anoop S.; Charlagorla, P.; Tume, Sebastian C.; Chhabra, Manoj; Narula, Pramod; Nadroo, Ali M.

doi:10.1038/jp.2013.96

Cited by 50 publications

(46 citation statements)

References 11 publications

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“…Peripherally inserted central catheters are critical tools for neonatal providers, and safe, efficient bedside imaging tools may help decrease PICC complication rates. The use of US to localize central lines in the NICU has been well described . Ultrasound‐guided PICC placement has been shown to decrease line manipulations and radiographs, but US for ongoing PICC monitoring has not been widely used.…”

Section: Discussionmentioning

confidence: 99%

Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit

Motz

Arnim

Likes³

et al. 2018

J of Ultrasound Medicine

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Objectives To assess whether a limited ultrasound (US) scanning protocol to monitor the upper extremity peripherally inserted central catheter (PICC) location in neonates is feasible for experienced US operators. Methods A radiologist, who was blinded to the PICC location on chest radiography, performed 14 US scans on 11 neonates with upper extremity PICCs. A US machine with 13–6‐MHz linear and 8–4‐MHz phased array transducers was used for the examinations. Results The study population included 54% (n = 6) preterm infants, with 72% (n = 8) weighing less than 1500 g. The US location of the PICC was the same as the chest radiographic report in all 14 scans. A subclavicular long‐axis view of the anterior chest visualized all PICCs in the subclavian or brachiocephalic veins. A parasternal long‐axis right ventricular inflow view was able to visualize PICCs in the superior vena cava (SVC), and a subcostal long‐axis view evaluated PICCs in the lower SVC and heart. The scanning time was location dependent: less than 5 minutes for PICCs in the brachiocephalic or subclavian vein and 5 to 10 minutes for PICCs in the SVC or heart. There were no desaturations below 90%, increases in the fraction of inspired oxygen need, or hypotension episodes during scanning. Conclusions A limited US scanning protocol to determine the upper extremity PICC location is feasible. Our protocol needs to be tested in neonatal providers before further dissemination.

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Section: Discussionmentioning

confidence: 99%

Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit

Motz

Arnim

Likes³

et al. 2018

J of Ultrasound Medicine

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“…Hence, the recent consensus is that echocardiography should be considered to confirm correct placement of UVCs. A recent study reported that echocardiography carried out by trained house-staff paediatricians to determine the UVC tip position had a high accuracy rate with an area under the receiver operating characteristic curve of 0.81, when compared with scans performed by a cardiologist 13. Hence training treating physicians and house-staff paediatricians in—and making them aware of the need for—echocardiography to confirm UVC placement is not only more feasible but is also reliable.…”

Section: Discussionmentioning

confidence: 99%

Advantages of being diligent: lessons learnt from umbilical venous catheterisation in neonates

et al. 2016

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Umbilical venous catheters (UVCs) are commonly used in neonatal units. Abdominal radiograph, taken soon after the insertion, is used to confirm the correct placement of the catheter. However, as demonstrated by our case series, complacency when an initial UVC is normally positioned can lead to detecting UVC-related complications very late. We describe cases of three neonates where, despite the initial UVC being confirmed to be well positioned, the patients developed life-threatening complications, including liver haematoma, left atrial thrombus and pericardial effusion causing cardiac tamponade. The routine use of point of care echocardiography helped in the early diagnosis of these complications. We suggest repeated echocardiographic screening at regular intervals in all newborn babies requiring UVCs, to ensure that the catheter is maintained in the proper position and for the early detection of catheter-related complications.

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“…Bedside sonography is becoming the gold standard to confirm UVC position 13. Radiography has been found to be unreliable, because the level of the IVC right atrial junction was seen to vary widely from T6-T11 6.…”

Section: Discussionmentioning

confidence: 99%

“…Hoellering et al 14 found that the cardiac silhouette method was superior to the vertebral level method to confirm the UVC position in the abdominal radiograph, but the diagnostic accuracy of both the methods was found to be less when compared to sonography. Studies have shown that sonography identified malposition of the catheter in cases in which the position of the catheter on the X-ray was found to be normal 6 13. However, the unavailability of a good ultrasound machine with appropriate probes and lack of expertise limit the use of sonography to confirm UVC position in many centres.…”

Section: Discussionmentioning

confidence: 99%

Pleural effusion caused by a malpositioned umbilical venous catheter in a neonate

Abiramalatha

Kumar²,

Shabeer

2015

BMJ Case Reports

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SUMMARYUmbilical venous catheterisation (UVC) insertion is a common procedure performed in most neonatal units. We report a case of a neonate who developed pleural and pericardial effusions and ascites due to a malpositioned UVC causing diaphragmatic perforation. Timely diagnosis using bedside sonography and prompt removal of the catheter resulted in resolution of the effusions without undue complications. BACKGROUND

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Superiority of targeted neonatal echocardiography for umbilical venous catheter tip localization: accuracy of a clinician performance model

Abstract: TnECHO is superior to chest radiography for identifying malpositioned catheters. TnECHO performed by pediatric housestaff physicians with basic training, demonstrated high-accuracy rates.

Cited by 50 publications

References 11 publications

Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit

Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit

Advantages of being diligent: lessons learnt from umbilical venous catheterisation in neonates

Pleural effusion caused by a malpositioned umbilical venous catheter in a neonate

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