Ultrasonography for Central Catheter Placement in the Neonatal Intensive Care Unit—A Review of Utility and Practicality

Abstract

Objective Central catheters (CCs) are routinely used in the neonatal intensive care unit (NICU). Ultrasonography (US) has been advocated as a procedural adjunct for CC placement to better localize catheter tip position (CTP), minimize radiation exposure, and decrease procedural burden. This review evaluates the clinical benefit, practical considerations for implementation, and limitations of US for CC placement in the NICU.

Study Design A literature search was conducted using the Pubmed and Ovid databases with search terms regarding the ultrasound modality relating to CCs in infants and neonates.

Results Five studies regarding US-guided CC insertions and seven studies describing postinsertion US were determined pertinent to this review's objective and discussed.

Conclusions At this time, the literature seems insufficient to recommend US as a replacement for radiography for CTP confirmation; however, US-guidance during insertion followed by radiographic verification can decrease line manipulations and repeat radiographs. Postinsertion assessments by US can better determine the CTP and guide repositioning decisions, reducing the likelihood of malposition and potential complications, and may be more practical for many NICUs. However, it is unclear how much training and experience is necessary to deem an individual competent for reliable and clinically beneficial bedside US evaluations.

Keywords

central catheter - umbilical catheter - central line - umbilical line - catheter insertion - ultrasonography - echocardiography - line placement

• References

• 1 Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child 1966; 41 (215) 69-75
• 2 Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child 1986; 140 (8) 786-788
• 3 Oppenheimer DA, Carroll BA, Garth KE, Parker BR. Sonographic localization of neonatal umbilical catheters. AJR Am J Roentgenol 1982; 138 (6) 1025-1032
• 4 George L, Waldman JD, Cohen ML , et al. Umbilical vascular catheters: localization by two-dimensional echocardio/aortography. Pediatr Cardiol 1982; 2 (3) 237-243
• 5 Ades A, Sable C, Cummings S, Cross R, Markle B, Martin G. Echocardiographic evaluation of umbilical venous catheter placement. J Perinatol 2003; 23 (1) 24-28
• 6 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. Am J Perinatol 2012; 29 (2) 101-106
• 7 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 (11) 1381-1384
• 8 Tauzin L, Sigur N, Joubert C, Parra J, Hassid S, Moulies M-E. Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants. Acta Paediatr 2013; 102 (7) 703-706
• 9 Froehlich CD, Rigby MR, Rosenberg ES , 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. Crit Care Med 2009; 37 (3) 1090-1096
• 10 Chamberlain MC, Reid SR, Madhok M. Utilization of emergency ultrasound in pediatric emergency departments. Pediatr Emerg Care 2011; 27 (7) 628-632
• 11 Marin JR, Zuckerbraun NS, Kahn JM. Use of emergency ultrasound in United States pediatric emergency medicine fellowship programs in 2011. J Ultrasound Med 2012; 31 (9) 1357-1363
• 12 Garg AK, Houston AB, Laing JM, MacKenzie JR. Positioning of umbilical arterial catheters with ultrasound. Arch Dis Child 1983; 58 (12) 1017-1018
• 13 Greenberg M, Movahed H, Peterson B, Bejar R. Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr 1995; 126 (4) 633-635
• 14 Fleming SE, Kim JH. Ultrasound-guided umbilical catheter insertion in neonates. J Perinatol 2011; 31 (5) 344-349
• 15 Katheria AC, Fleming SE, Kim JH. A randomized controlled trial of ultrasound-guided peripherally inserted central catheters compared with standard radiograph in neonates. J Perinatol 2013; 33 (10) 791-794
• 16 Brissaud O, Harper L, Lamireau D, Jouvencel P, Fayon M. Sonography-guided positioning of intravenous long lines in neonates. Eur J Radiol 2010; 74 (3) e18-e21
• 17 Madar RJ, Deshpande SA. Reappraisal of ultrasound imaging of neonatal intravascular catheters. Arch Dis Child - Fetal and Neonatal Edition 1996; 75 (1) F62-F64
• 18 Simanovsky N, Ofek-Shlomai N, Rozovsky K, Ergaz-Shaltiel Z, Hiller N, Bar-Oz B. Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol 2011; 21 (9) 1882-1886
• 19 Michel F, Brévaut-Malaty V, Pasquali R , et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation 2012; 83 (6) 705-709
• 20 Green C, Yohannan MD. Umbilical arterial and venous catheters: placement, use, and complications. Neonatal Netw 1998; 17 (6) 23-28
• 21 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 (2) E28
• 22 Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 2013; 33 (4) 307-312
• 23 Sharpe E, Pettit J, Ellsbury DL. A national survey of neonatal peripherally inserted central catheter (PICC) practices. Adv Neonatal Care 2013; 13 (1) 55-74