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29.10.2018 | Original Article | Ausgabe 2/2019

European Journal of Pediatrics 2/2019

The superiority of point of care ultrasound in localizing central venous line tip position over time

European Journal of Pediatrics > Ausgabe 2/2019
Nahla Zaghloul, Laura Watkins, Jennie Choi-Rosen, Shahana Perveen, Dalibor Kurepa
Wichtige Hinweise
Communicated by Patrick Van Reempts

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00431-018-3269-9) contains supplementary material, which is available to authorized users.


The primary objective was to study agreement between X-rays and point of care ultrasound (POC-US) in determining central venous line (CVL) tip position. The secondary objective was to examine malposition rates over time using POC-US. Fifty-six neonates were enrolled who had a CVL placed. Initial X-rays and POC-US were obtained. POC-US was performed daily thereafter for the total of 6 days. US video clips were acquired in four standard echocardiographic views: subcostal, four-chamber, and short- and long-axis parasternal views. Gwet’s agreement coefficient (AC1) for agreement measured inter-rater reliability of X-rays and POC-US (correct position/malposition). A generalized linear mixed model for binary clustered data estimated malposition rate over time. All analyses were conducted using SAS version 9.4 and Agree Stat. The study included 108 “pairs” of X-rays and POC-US images. Agreement coefficient (AC1), with respect to correct position/malposition of CVL tip, was high AC1 = 0.872 (UVC-AC1 = 0.814, PICC-AC1 = 0.94). Among birth weight (BW) < 1000 g, 1000–1499 g, and BW > 1500 g, AC1 values were 0.922, 0.774, and 0.873, respectively. CVL tip malposition rate decreased over time.
Conclusions: Agreement between POC-US and X-rays for CVL tip position was high, with the highest in BW < 1000 g. The data suggest that POC-US can be used for initial confirmation and follow up of CVL tip position.
What is Known
• X-ray is currently the gold standard for localizing central venous line (CVL) tip position.
• Malposition of CVL tip can lead to life-threatening complications.
What is New
• POC-US is superior to X-ray as it can follow CVL tip position over time, detecting malpositioned lines, adjusting them in a timely manner thus preventing complications.
• Standardizing CVL placement, X-ray acquisition, POC-US acquisition with four views with video clips and ultrasound operator training increases accuracy and thus agreement between X-ray and POC-US.
• UVC tip is more likely to be malpositoned than PICC tip. Malposition of UVC tip using POC-US decreased over time due to shrinking of the umbilical cord in the first 48 of life.

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