Ultrasound guided catheter tip location in neonates
Abstract:
Objective: To assess Point of Care Ultrasound (POCUS) guided catheter tip location in a neonatal cohort after insertion of percutaneously inserted central catheters (PICCs) from the upper part of the body.
Study design: This was a prospective, observational study on PICC tip location. Tip site was assessed by radiological landmarks or direct ultrasound (US) visualization of the cardiovascular structures.
Results: One-hundred eighteen PICCs (28 G/1 Fr) were studied in 102 neonates (mean postmenstrual age: 31 weeks [range 25-43]; mean weight at positioning: 1365 grams [range 420-4180]). Feasibility of POCUS guided tip location was 92.3% in our population. Failures were significantly associated with mechanical ventilation (aOR 5.33, 95% CI [1.13; 29.5], p=0.038). Agreement between US and radiographic methods was found in 88 out of 109 cases (80.7%). Fifteen out of 21 discordant cases led to a change in clinical management.
Conclusion: POCUS guided localization of small bore PICC is a non-invasive and effective alternative to the conventional radiogram. The latter should be recommended when US fails to locate the catheter tip.
Reference:
Grasso F, Capasso A, Pacella D, Borgia F, Salomè S, Capasso L, Raimondi F. Ultrasound guided catheter tip location in neonates: a prospective cohort study. J Pediatr. 2021 Dec 28:S0022-3476(21)01266-X. doi: 10.1016/j.jpeds.2021.12.059. Epub ahead of print. PMID: 34971654.