Download PDF
Am J Perinatol 2012; 29(02): 101-106
DOI: 10.1055/s-0031-1295649
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Use of Targeted Neonatal Echocardiography to Confirm Placement of Peripherally Inserted Central Catheters in Neonates

Amish Jain
1   Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, c/o Women’s College Hospital;
2   Department of Pediatrics, Mount Sinai Hospital;
,
Patrick J. McNamara
3   Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.
,
Eugene Ng
1   Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, c/o Women’s College Hospital;
,
Afif El-Khuffash
2   Department of Pediatrics, Mount Sinai Hospital;
› Author Affiliations
Further Information

Publication History

26 April 2011

11 July 2011

Publication Date:
21 November 2011 (online)

    Permissions and Reprints

Abstract

The use of plain radiographs in assessing the correct position of peripherally inserted central catheter (PICC) line tips is not always accurate. Ultrasound may be a better modality in detecting tip position and aid in line manipulation. We assessed the accuracy of plain radiographs in determining PICC line tip position compared with using targeted neonatal echocardiography (TnECHO) in a tertiary neonatal intensive care unit. Following PICC insertion, tip position was confirmed using TnECHO after the first radiograph. A 2 × 2 table was constructed to compare the two modalities’ ability to detect line position. A total of 22 infants were included in the study with a gestation of 26.5 weeks (25.4 to 28.8) and birth weight of 833 g (710 to 1930). Concordance between radiographs and TnECHO for PICC line tip position occurred in 13 infants (59%). Sensitivity of radiographs in determining malposition was 64% with a specificity of 55%. Three infants were incorrectly identified to have deep lines and two infants were incorrectly identified to have short lines. In nine infants (41%), a second radiograph was avoided following line manipulation using TnECHO. TnECHO is a useful tool in identifying tip position, performing real-time manipulation, and minimizing exposure to further radiographs.

Keywords

echocardiography - preterm infants - PICC lines - radiographs
 

  • References

  • 1 Sneath N. Are supine chest and abdominal radiographs the best way to confirm PICC placement in neonates?. Neonatal Netw 2010; 29: 23-35
    CrossrefPubMedGoogle Scholar
  • 2 Pettit J. Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications. Adv Neonatal Care 2003; 3: 14-26
    CrossrefPubMedGoogle Scholar
  • 3 Pettit J. Assessment of infants with peripherally inserted central catheters: Part 1. Detecting the most frequently occurring complications. Adv Neonatal Care 2002; 2: 304-315
    CrossrefPubMedGoogle Scholar
  • 4 Pettit J. Technological advances for PICC placement and management. Adv Neonatal Care 2007; 7: 122-131
    CrossrefPubMedGoogle Scholar
  • 5 Camara D. Minimizing risks associated with peripherally inserted central catheters in the NICU. MCN Am J Matern Child Nurs 2001; 26: 17-21 ; quiz 22
    CrossrefPubMedGoogle Scholar
  • 6 Sehgal A, McNamara PJ. Does point-of-care functional echocardiography enhance cardiovascular care in the NICU?. J Perinatol 2008; 28: 729-735
    CrossrefPubMedGoogle Scholar
  • 7 Nadroo AM, Glass RB, Lin J, Green RS, Holzman IR. Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics 2002; 110 (1 Pt 1) 131-136
    CrossrefPubMedGoogle Scholar
  • 8 Darling JC, Newell SJ, Mohamdee O, Uzun O, Cullinane CJ, Dear PR. Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol 2001; 21: 461-464
    CrossrefPubMedGoogle Scholar
  • 9 Darling JC, Newell SJ, Dear PR. Placement of neonatal central venous catheter tips in the right atrium: a practice to be avoided?. Arch Dis Child Fetal Neonatal Ed 2001; 85: F146
    PubMedGoogle Scholar
  • 10 Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002; 110 (1 Pt 1) 137-142
    CrossrefPubMedGoogle Scholar
  • 11 Chait PG, Ingram J, Phillips-Gordon C, Farrell H, Kuhn C. Peripherally inserted central catheters in children. Radiology 1995; 197: 775-778
    PubMedGoogle Scholar
  • 12 Fricke BL, Racadio JM, Duckworth T, Donnelly LF, Tamer RM, Johnson ND. Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position. Radiology 2005; 234: 887-892
    CrossrefPubMedGoogle Scholar
  • 13 Racadio JM, Doellman DA, Johnson ND, Bean JA, Jacobs BR. Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics 2001; 107: E28
    CrossrefPubMedGoogle Scholar
  • 14 Hogan MJ. Neonatal vascular catheters and their complications. Radiol Clin North Am 1999; 37: 1109-1125
    CrossrefPubMedGoogle Scholar
  • 15 Diemer A. Central venous silastic catheters in newborns: localization by sonography and radiology. Pediatr Radiol 1987; 17: 15-17
    CrossrefPubMedGoogle Scholar
  • 16 Ohki Y, Tabata M, Kuwashima M, Takeuchi H, Nako Y, Morikawa A. Ultrasonographic detection of very thin percutaneous central venous catheter in neonates. Acta Paediatr 2000; 89: 1381-1384
    CrossrefPubMedGoogle Scholar
  • 17 Connolly B, Amaral J, Walsh S, Temple M, Chait P, Stephens D. Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs). Pediatr Radiol 2006; 36: 845-850
    CrossrefPubMedGoogle Scholar