Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Epicutaneo-Caval Catheter Placement in Neonates

Abstract

Objective Epicutaneo-caval catheters (ECCs) are essential for the care of sick infants who require long-term medical and nutritional management. The aim of this study was to investigate the use of real-time ultrasound as an alternative to X-rays to reduce the incidence of primary malpositions during catheter insertion.

Study Design Data on ECCs were retrospectively collected in a tertiary neonatal intensive care unit. Catheter were analyzed considering the tip location technique (standard chest–abdominal radiograph vs real-time ultrasound)

Results A total of 248 ECCs were analyzed. Of these, 118 catheters had primary malposition (47.6%). The tip of 165 catheters was assessed using standard chest–abdominal X-rays and 107 (64.8%) were found to be in an inappropriate location. In the group of 83 catheters that were placed using real-time ultrasound for tip location, only 11 catheters (13.2%) had primary malposition. The rate of malposition among the two groups showed a statistically significant difference (p < 0.001). Hypothetically, 300 chest X-rays could have been saved if real-time ultrasound had been used to locate the tip, reducing radiation exposure to infants.

Conclusion The use of a real-time ultrasound may be beneficial in reducing primary catheter malpositions compared with conventional radiography. In addition, secondary malpositions and catheter-related complications can be monitored over time.

Key Points

• Conventional radiology cannot be considered the “gold standard” for ECC tip location.

• Ultrasound is more accurate and reduces insertion time reducing the rate of primary malposition.

• Ultrasound can be performed in real time and it is the best technique for ECC tip location in infants.

Keywords

epicutaneo-caval catheters - radiation exposure - real-time ultrasound

Statement of Ethics

The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. Written informed consents were obtained from the parents of all patients for publication and any accompanying images. These data are part of a larger study that was approved by the Ethics Committee of the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (ID 3104).

Authors' Contributions

• V. D. and G. P.: Substantial contributions to the conception and design of the work.

• G. P. and F. C.: Acquisition, analysis, and interpretation of data for the work.

• R. R., G. B., and G. V.: Drafting the work or revising it critically for important intellectual content.

• V. D., G. P., F. C., R. R., G. B., and G. V.: Final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Data Availability Statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

^* These authors contributed equally to this work.

Publication History

Received: 05 October 2022

Accepted: 13 December 2022

Article published online:
24 January 2023

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