Ultrasound-guided Tunneled Lower Extremity Peripherally Inserted Central Catheter Placement in Infants (original) (raw)
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BMJ Open
ObjectivesWe aimed to compare the success rates and other catheter-related parameters between peripherally inserted central catheters (PICCs) and non-tunnelled ultrasound-guided central venous catheters (USG-CVCs) including femoral, jugular, brachiocephalic and subclavian lines.DesignThis was a retrospective observational study.SettingThe study was performed in a level III neonatal intensive care unit (NICU) in Qatar, as a single-site study.ParticipantsThis study included 1333 neonates who required CVC insertion in the NICU from January 2016 to December 2018. Of those, we had 1264 PICCs and 69 non-tunnelled USG-CVCs.Outcome measuresThe success rate and other catheter-related complications in the two groups.ResultsThe overall success rate was 88.4% in the USG-CVCs (61/69) compared with 90% in the PICCs (1137/1264) group (p=0.68). However, the first prick success rate was 69.4% in USG-CVCs (43/69) compared with 63.6% in the PICCs (796/1264) group. Leaking and central line-associated b...
Pediatric emergency care, 2009
We hypothesized that the use of ultrasound guidance would improve the success rate of peripheral intravenous catheter placement in pediatric patients with difficult access in a pediatric emergency department (ED). Our secondary hypotheses were that ultrasound guidance would reduce the number of attempts, the number of needle redirections, and the overall time to catheter placement. This was a prospective randomized study of pediatric ED patients younger than 10 years old requiring intravenous access, presenting between August 2006 and May 2007. Inclusion criteria were 2 unsuccessful traditional attempts at peripheral intravenous access or history of difficult access. Exclusion was critical illness or instability. Patients were randomized to undergo peripheral intravenous catheter placement using continued traditional approaches or real-time, dual-operator ultrasound-guided technique. Measured outcomes were success of cannulation, number of attempts, number of needle redirections, an...
Ultrasound guidance for central vascular access in the neonatal and pediatric intensive care unit
Saudi Journal of Anaesthesia, 2012
Background: Percutaneous central venous cannulation (CVC) in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmarkguided technique. recent guidelines from the National institute for Clinical Excellence (NiCE) recommend the use of ultrasound guidance for central venous catheterization in children. the purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein), incidence of complication, and the ease of use for central venous access in the neonatal age group. Methods: after approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0-204) months and weight 9.3 (1.9-60) kg). Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics ® Burroughs, USa) covered by a sterile sheath. outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications. Results: Cannulation of the central vein was 100% successful in all patients. the right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. the median access time (skin to vein) for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique. Conclusions: in a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. it improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in neonatal and pediatric patients.
Iranian Journal of Pediatrics, 2020
Background: Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography. Objectives: We compared the effectiveness of sonography with radiography for confirmation of the line tip placement. Methods: This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both met...
Umbilical venous catheter position: evaluation by ultrasound
European Radiology, 2011
Objective Umbilical venous catheter (UVC) insertion is frequently performed in critically ill neonates, with catheter position evaluated by an abdominal radiograph. The position of the catheter can be difficult to assess based on supine film alone. We aimed to determine whether ultrasound enables precise evaluation of the catheter tip position. Methods We prospectively evaluated UVC position in 75 neonates by ultrasound and supine abdominal radiograph. Distance from the catheter tip to the diaphragm was measured for both modalities. Anatomical location of the catheter was recorded for both studies. The Student's t-test was used to compare the means of the differences in catheter position on radiograph and ultrasound. Results In 46 patients there was no difference in the distance between the catheter tip and the diaphragm on ultrasound and radiograph. In 29 babies there was a difference of 1-to-7 mm. Ultrasound identified malposition of the catheter in three cases in which the position of the catheter on the plain film was deemed acceptable. Conclusions Our study suggests that ultrasound is reliable and may replace plain radiograph for the identification of the UVC position, preventing complications from malposition, and reducing exposure to ionizing radiation.
Placement of peripherally inserted central catheters in children guided by ultrasound
Pediatric Critical Care Medicine, 2012
Purpose: To evaluate a recently developed technique to place a medium-duration(weeks to months) central venous access. Materials and Methods : Within three-year period , 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter(PICC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm , eitherthe brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5-French silicone catheter was introduced with its distal tip to thejunction of the right atrium and superior vena cava. Results: Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients(2.5% }, acute thrombosis ofthesubclavian vein in 3(0.5%). Occluded catheters i n 4 patients were easi Iy clea red with u roki nase i n pl ace. Conclusion : The PICC system is an excellent option for medium-duration central venous access. Patients were able to carry on normal activit ies with the catheters in place. 'Oepartmen tolRadiology, Samsung Medi cal Center 20epartm entol Radiology , Mayo Clinic 30epartment ofRadiology , Un iversity 01 Michigan Hospitals
Pediatric Critical Care Medicine, 2013
Objectives: To assess the feasibility of ultrasound-guided supraclavicular catheterization of the subclavian vein in pediatric and neonatal ICU. Design: Retrospective cohort. Setting: Ten-bed pediatric medicosurgical ICU and 15-bed neonatal ICU. Patients: Children and newborns undergoing supraclavicular ultrasound-guided subclavian vein catheterization from March 2010 to September 2010. Measurements: The placement of central venous catheter in ICU was carried out either by one of the experts in ultrasound-guided puncture of the unit or by a novice completely supervised by the expert. The success and the early complications were recorded. A comparison between novice and expert operators was also made. Results: Forty-two catheters were placed in 40 children. The median age and median weight were, respectively, 6.5 months and 6.5 kg. The success rate was 97.6% (one failure) and the early complication rate was 4.7% (one pneumothorax and one arterial puncture); 61% of children breathed spontaneously during the catheter placement. No significant difference was found between expert and novice operators. Conclusions: Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICU seems to be a promising technique in the context of emergency. It is safe, reliable, with few early complications. Furthermore, it does not compromise the airways of the patient owing to the low level of sedation needed for its placement.
Pediatric Radiology, 2022
Background Chest radiography after peripherally inserted central catheter insertion in infants is the reference standard method for verifying catheter tip position. The utilisation of ultrasound (US) for catheter placement confirmation in the neonatal and paediatric population has been the focus of many recent studies. Objective In this systematic review we investigated the diagnostic accuracy of US for peripherally inserted central catheter tip confirmation in infants in the neonatal intensive care unit (NICU) Materials and methods We conducted a systematic literature search of multiple databases. The study selection yielded eight articles, all of which had acceptable quality and homogeneity for inclusion in the meta-analysis. Sensitivity and specificity values were reported together with their respective 95% confidence intervals (CI). Results After synthesising the eligible studies, we found that US had a sensitivity of 95.2% (95% CI 91.9-97.4%) and specificity of 71.4% (95% CI 59.4-81.6%) for confirming catheter tip position. Conclusion Analyses indicated that US is an excellent imaging test for localising catheter tip position in the NICU when compared to radiography. Ultrasonography is a sensitive, specific and timely imaging modality for confirming PICC tip position. In cases where US is unable to locate malpositioned PICC tips, a chest or combined chest-abdominal radiograph should be performed.
Frontiers in Pediatrics
Introduction:Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. The aim of our study was to determine whether the repeated ultrasound scanning can influence the catheterization time, prevent some of the catheter-related complications, support the decision-making process and allow prolonged catheterization in patients without an alternative central access route.Methods:A prospective observational study was performed in a tertiary neonatal intensive care unit. A total of 129 patients and 194 umbilical catheters (119 venous and 75 arterial) were analyzed with a total of 954 scans. Ultrasound screening consisted of 1) assessing the catheter tip, location, movability, and surface and 2) analyzing the catheter trajectory. The outcome variables were defined as 1) catheter dislocation and 2) associated thrombosis.Results:Dislocation of catheter throughout the whole catheterization period was observed in 68% (81/119) of UVC...
Acta Anaesthesiologica Scandinavica, 2012
Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search of the current literature. Although the literature is heterogeneous with few randomised studies, PICCs emerge as a safe and valuable option for intermediate-to longterm central venous access in children both in and out of hospital. Insertion can often be performed in light or no sedation, with little risk of perioperative complications. Assisted visualisation, preferably with ultrasound, yields high rates of insertion success. With good catheter care, rates of mechanical, infectious and thrombotic complications are low and compare favourably with those of traditional central venous catheters. Even in the case of occlusion or infection, fibrinolytics and antibiotic locks often allow the catheter to be retained.