“Percutaneous long lines (LL) are routinely used in preterm babies for providing parenteral nutrition (PN). Malpositioning of LL tips is associated with serious complications.(1-5) No national guidelines exist outlining the best imaging techniques to establish LL position.”
Caffrey Osvald, E., Hill, L. and Ramalingam, V. (2014) PC.128 National Survey on Imaging of Percutaneous Longlines in Tertiary Neonatal Intensive Care Units. Archives of Disease in Childhood. Fetal and Neonatal Edition. 99(Suppl 1), p.A80.
How to determine neonatal long line tip location http://ctt.ec/07P83+ @ivteam #ivteam
INTRODUCTION: Percutaneous long lines (LL) are routinely used in preterm babies for providing parenteral nutrition (PN). Malpositioning of LL tips is associated with serious complications.(1-5) No national guidelines exist outlining the best imaging techniques to establish LL position.
AIM: To determine how tertiary neonatal intensive care units (previously Level 3 Neonatal Units) across the UK ascertain LL position.
METHOD: All fifty-two tertiary neonatal intensive care units in the UK were contacted. It was established whether they followed local/regional guidelines regarding insertion and imaging of LL. Information was collected on imaging modalities used to establish LL tip position and procedure following LL adjustment.
RESULTS: 40/52 units have guidelines on LL insertion and post-insertion imaging. 26/52 units used plain X-ray alone and 9/52 units used X-ray with contrast, the rest used a combination of both to ascertain LL position. 10 units used contrast when Premicaths® were inserted. Following line adjustment, 21 units did not routinely perform a repeat X-ray. 17 units used plain X-ray, 5 units utilised X-ray with contrast and 9 units used a combination of X-ray with contrast and/or plain X-ray depending on the LL type and position.
CONCLUSIONS: Variation in practice across the UK exists regarding LL position. Some of these differing practices likely pertain to the perceived best imaging technique of the various LL available on the market. Further research into the best imaging techniques for each available LL is warranted to determine national guidelines, which would aid in reducing complications from LL insertion.
REFERENCES: Cartwirght DW. Central venous lines in neonates: a study of 2186 catheters. Arch Dis Child Fetal Neonatal Ed 2004; 89:F504-F508 Daniels SR, Hannon D, Meyer RA, et al. Paroxysmal supraventricular tachycardia: a complication of jugular central venous catheters in neonates. Am J Dis Child 1984;138:474-475 Pizzuti A, Parodi E, Abbondi P, et al. Cardiac tamponade and successful pericardiocentesis in an extremely low birth weight neonate with percutaneously inserted central venous line: a case report. Cases Journal 2010;3:1757-1626 Warren M, Thompson KS, Popek EJ, et al. Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization. Ann Clin Lab Sci 2013;43:163-171 Chen CC, Tsao PN, Yau KI. Paraplegia: complication of percutaneous central venous line malposition. Pediatr Neurol 2001;23:65-68.
Other intravenous and vascular access resources that may be of interest (External links – IVTEAM has no responsibility for content).
- Guide for intravenous chemotherapy and associated vascular access devices from Macmillan.
- CancerUK IV chemotherapy information.