Comparing the Accuracy of Echocardiography and Radiography for Evaluation of Tip Position of Peripherally Inserted Central Catheters: Experienced in an NICU in Iran

Document Type : original article

Authors

1 Division of Neonatology, Department of Pediatrics Children’s Medical Center Tehran University of Medical Sciences

2 Pediatrics Department of Pediatrics, Division of pediatric cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran

3 1. Associate professor, Neonatal Health Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Division of Neonatology, Department of Pediatrics, Children&a

4 Bc of Nursing, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

5 Msc of Neonatal Intensive Care Nursing. Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

6 Maternal & Child Health Specialist, Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Echocardiography (ECHO) is a non-radiation real-time technique for evaluating Peripherally Inserted Central Catheter (PICC) tips that could overcome the limitations of plain radiographs, including the static and single image and exposing neonates to radiation. This study compared the accuracy of ECHO and radiography for PICC tip positioning in neonates.  
Methods: This cross-sectional pilot study was conducted in the neonatal intensive care unit (NICU) of the Children's Medical Center in Tehran, Iran. Ultrasonography was used to visualize the end of the catheter in the vessels. After insertion of the catheter, a chest x-ray along with the ECHO was performed by a pediatric cardiologist blinded to the preliminary radiographic reports, and the results were compared and interpreted.
Results: Forty infants with mean gestational ages of 35.4±3.3 weeks were enrolled in this study which was conducted during 12 months, from 2019 to 2020. The radiography results confirmed the correct PICC location in 29 infants (72.5%), which was simultaneously confirmed by ECHO in 28 infants (70.0%). The ECHO results indicated inappropriate placement in 12 infants (30%), and radiographs indicated correct placement in 11 infants (27.5%). This confirmed the higher accuracy of ECHO 

Keywords

References

  1. Sharma D, Farahbakhsh N, Tabatabaei SA. Role of ultrasound for central catheter tip localization in neonates: a

placement in the neonatal intensive care unit—a review of utility and practicality. American Journal of Perinatology. 2016;33(06):525-30.

  1. Westergaard B, review of the current evidence. The Journal of Maternal-Fetal & Neonatal Medicine. 2019; 32(14):2429-37.
  2. McCay AS, Elliott EC, Walden M. Videos in clinical medicine. PICC placement in the neonate. The New England Journal of medicine. 2014; 370(11):e17-e.
  3. Bloemen A, Daniels AM, Samyn MG, Janssen RJ, Elshof J-W. Electrocardiographic-guided tip positioning technique for peripherally inserted central catheters in a Dutch teaching hospital: Feasibility and cost-effectiveness analysis in a prospective cohort study. The Journal of Vascular Access. 2018; 19(6):578-84.
  4. McCay AS, Elliott, E.C., Walden, M. PICC Placement in the Neonate. N Engl J Med. 2014; 370(22):2154.
  5. Perin G, Scarpa M-G. Defining central venous line position in children: tips for the tip. The Journal of vascular access. 2015; 16(2):77-86.
  6. Ahn J, Kim I, Yang J, Lee I, Seo D, Kim S. Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres’ formula or a radiological landmark-based approach: a prospective randomized single-center study. BJA: British Journal of Anaesthesia. 2017; 118(2):215-22.
  7. Jain A, McNamara PJ, Ng E, El-Khuffash A. The use of targeted neonatal echocardiography to confirm placement of peripherally inserted central catheters in neonates. American journal of perinatology. 2012; 29(02):101-6.
  8. Tauzin L, Sigur N, Joubert C, Parra J, Hassid S, Moulies ME. Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants. Acta Paediatrica. 2013; 102(7):703-6.
  9. Nguyen J. Ultrasonography for central catheter Classen V, Walther‐Larsen S. Peripherally inserted central catheters in infants and children–indications, techniques, complications and clinical recommendations. Acta Anaesthesiologica Scandinavica. 2013; 57(3):278-87.
  10. Bourgeois FC, Lamagna P, Chiang VW. Peripherally inserted central catheters. Pediatric emergency care. 2011; 27(6):556-61.
  11. Sneath N. Are supine chest and abdominal radiographs the best way to confirm PICC placement in neonates? Neonatal Network. 2010; 29(1):23-35.
  12. Ohki Y, Tabata M, Kuwashima M, Takeuchi H, Nako Y, Morikawa A. Ultrasonographic detection of very thin percutaneous central venous catheter in neonates. Acta Paediatrica. 2000; 89(11):1381-4.
  13. Javeri Y, Jagatkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2020; 24(Suppl 1):S6.
  14. Ren X-L, Li H-L, Liu J, Chen Y-J, Wang M, Qiu R-X. Ultrasound to localize the peripherally inserted central catheter tip position in newborn infants. American Journal of Perinatology. 2021; 38(02):122-5.
  15. El-Khuffash AF, McNamara PJ, editors. Neonatologist-performed functional echocardiography in the neonatal intensive care unit. Seminars in Fetal and Neonatal Medicine; 2011: Elsevier.
  16. Jain A, McNamara PJ, Ng E, El-Khuffash A. The use of targeted neonatal echocardiography to confirm placement of peripherally inserted central catheters in neonates. American journal of perinatology. 2012; 29(2):101.
  17. Marcelino PA, Marum SM, Fernandes APM, Germano N, Lopes MG. Routine transthoracic echocardiography in a general Intensive Care Unit: an 18 month survey in 704 patients. European Journal of Internal Medicine. 2009; 20(3):e37-e42.
  18. Pulickal A, Charlagorla P, Tume S, Chhabra M, Narula P, Nadroo A. Superiority of targeted neonatal echocardiography for umbilical venous catheter tip localization: accuracy of a clinician performance model. Journal of Perinatology. 2013; 33(12):950-3.
  19. Yoon SZ, Shin JH, Hahn S, Oh AY, Kim HS, Kim SD, Kim CS. Usefulness of the carina as a radiographic landmark for central venous catheter placement in pediatric patients. British journal of anaesthesia. 2005; 95(4):514-7.
  20. Jain A, Sahni M, El-Khuffash A, Khadawardi E, Sehgal A, McNamara PJ. Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. The Journal of pediatrics. 2012; 160(4):584-9. e1.
  21. Kadivar M MZ, Ghaemi O, Sangsari R, Saeedi M, Shariat M, Mehdizadeh M, Mohamadi S, Majnoon MT, Mirnia K. Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the NICU. Iranian Journal of Pediatrics. 2020 Dec 1(In Press).
  22. Swaminathan L, Flanders S, Rogers M, Calleja Y, Snyder A, Thyagarajan R, Bercea P, Chopra V. Improving PICC use and outcomes in hospitalized patients: an interrupted time series study using MAGIC criteria. BMJ quality & safety. 2018; 27(4):271-8.
  23. Ades A, Sable C, Cummings S, Cross R, Markle B, Martin G. Echocardiographic evaluation of umbilical venous catheter placement. Journal of perinatology. 2003; 23(1):24-8.
  24. Diemer A. Central venous silastic catheters in newborns: localization by sonography and radiology. Pediatric radiology. 1987; 17(1):15-7.
  25. Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW; Writing Group of the American Society of Echocardiography (ASE); European Association of Echocardiography (EAE); Association for European Pediatric Cardiologists (AEPC). Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training: Writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). European Journal of Echocardiography. 2011; 12(10):715-36.
  26. Evans N, Gournay V, Cabanas F, Kluckow M, Leone T, Groves A, McNamara P, Mertens L., editors. Point-of-care ultrasound in the neonatal intensive care unit: international perspectives. Seminars in Fetal and Neonatal Medicine; 2011: Elsevier.
  27. Wood D, Respondek-Liberska M, Puerto B, Weiner S. Perinatal echocardiography: protocols for evaluating the fetal and neonatal heart. Journal of perinatal medicine. 2009; 37(1):5-11.
  28. Finan E, Sehgal A, Khuffash AE, McNamara PJ. Targeted neonatal echocardiography services: need for standardized training and quality assurance. Journal of Ultrasound in Medicine. 2014; 33(10):1833-41.
  29. Harabor A, Soraisham AS. Utility of targeted neonatal echocardiography in the management of neonatal illness. Journal of Ultrasound in Medicine. 2015; 34(7):1259-63.
  30. Shah P, Vasudev R, Pullatt R, Shamoon F. Peripherally inserted central catheter-induced right atrium thrombosis and superior vena cava dissection. Journal of the Association for Vascular Access. 2017; 22(1):20-1.
  31. Kim Y-H, Collins J, Li Z, Chinnadurai P, Kapoor A, Lin CH, Mansi T. Automated catheter tip repositioning for intracardiac echocardiography. International Journal of Computer Assisted Radiology and Surgery. 2022:1-9.
  32. Kim Y-H, Collins J, Li Z, Chinnadurai P, Kapoor A, Lin CH, Mansi T. Towards automatic manipulation of intraCardiac echocardiography catheter. arXiv preprint arXiv:200905859. 2020.
  33. Iacobone E, Elisei D, Gattari D, Carbone L, Capozzoli G. Transthoracic echocardiography as bedside technique to verify tip location of central venous catheters in patients with atrial arrhythmia. The Journal of Vascular Access. 2020:1129729820905200.
  34. Karber B, Nielsen J, Balsam D, Messina C, Davidson D. Optimal radiologic position of an umbilical venous catheter tip as determined by echocardiography in very low birth weight newborns. Journal of neonatal-perinatal medicine. 2017; 10(1):55-61.
  35. Fidler HL. The use of bedside ultrasonography for PICC placement and insertion. Advances in Neonatal Care. 2011; 11(1):52-3.
  36. Amerasekera S, Jones C, Patel R, Cleasby M. Imaging of the complications of peripherally inserted central venous catheters. Clinical radiology. 2009; 64(8):832-40.
  37. Yamamoto AJ, Solomon JA, Soulen MC, Tang J, Parkinson K, Lin R, Schears GJ. Sutureless securement device reduces complications of peripherally inserted central venous catheters. Journal of Vascular and Interventional Radiology. 2002; 13(1):77-81.
  38. Benham JR, Culp WC, Wright LB, McCowan TC. Complication rate of venous access procedures performed by a radiology practitioner assistant compared with interventional radiology physicians and supervised trainees. Journal of vascular and interventional radiology. 2007; 18(8):1001-4.
  39. Vesely TM. Central venous catheter tip position: a continuing controversy. Journal of Vascular and Interventional Radiology. 2003; 14(5):527-34.
  40. Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig P-LJ, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Critical care medicine. 2009; 37(3):1090-6.
Journal of Pediatric Perspectives
Volume 11, Issue 4
April 2023
Pages 17654-17664

Files

Share

How to cite

Statistics