Variation in identifying neonatal percutaneous central venous line position

Abstract

Interobserver and intraobserver reliability was poor when using radiographs to assess long line tips. The major determinant of line repositioning was the perceived location.

The reliability of 2D and colour Doppler ultrasound in localising longline position

“…In retrospect, this estimate was overly optimistic, as there was only 75% agreement in the 12 infants where both operators could identify the line position with colour Doppler. This degree of agreement is similar to that seen with the radiographic assessment, which – despite being regarded as the gold standard for localising longline position – ranges between 40 and 88%, with considerable intra‐observer variability 12 . Although digital radiography has been reported to improve the visibility of longline tip position compared with the hard copy films, 13 it does not necessarily improve the agreement between observers despite the ability to manipulate image quality 9 .…”

“…This degree of agreement is similar to that seen with the radiographic assessment, which -despite being regarded as the gold standard for localising longline positionranges between 40 and 88%, with considerable intra-observer variability. 12 Although digital radiography has been reported to improve the visibility of longline tip position compared with the hard copy films, 13 it does not necessarily improve the agreement between observers despite the ability to manipulate image quality. 9 The level of agreement of longline position between radiology observers in this study (68%) is similar to our previous studies using contrast radiography 14 and digital radiography.…”

Radiologist variability in assessing the position of the cavoatrial junction on chest radiographs

“…The sample size used in this study was consistent with those used in similar studies reported in the literature. 12,16 All CXRs were acquired to a standard technique 17 and acceptable image quality was verified by two of the study authors.…”

“…It is widely speculated that assessment of catheter tip position on CXR is inaccurate and subject to interobserver variability. [11][12][13][14][15] For CXR to be a valid tool it would require that a radiologist is able to reliably identify the CAJ position. To our knowledge, the accuracy of this task, in this specifically trained group, has not been assessed.…”

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

“…Different methods are used to assess longline tip position. The most common, plain radiography is plagued with concerns about poor intra- and inter-observer reliability[ 2 ]. Other modalities, e.g ., echocardiography[ 3 ] and CT[ 4 ] might be more reliable but are not readily available in most units.…”