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European Journal of Pediatrics

, Volume 178, Issue 2, pp 173–179 | Cite as

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

  • Nahla ZaghloulEmail author
  • Laura Watkins
  • Jennie Choi-Rosen
  • Shahana Perveen
  • Dalibor Kurepa
Original Article

Abstract

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.

Keywords

Point of care ultrasound (POC-US) X-ray Central venous line (CVL) Agreement Echocardiographic views 

Abbreviations

AC1

Agreement coefficient

AP

Anteroposterior

BW

Birth weight

CAJ

Cavoatrial junction

CVL

Central venous line

CIs

Confidence intervals

GLMM

Generalized linear mixed model

IVC

Inferior vena cava

LA

Left atrium

NICU

Neonatal intensive care unit

PICC

Peripherally inserted central catheter

POC-US

Point of care ultrasound

RA

Right atrium

SVC

Superior vena cava

US

Ultrasound

UVC

Umbilical venous catheter

Notes

Author contributions

NZ contributed to the conception, organization, and oversight of the study, data analysis and interpretation, the writing of the original manuscript draft, and final approval of the version to be published.

LW contributed to data analysis and interpretation, critical manuscript revision, and final approval of the version to be published.

JCR contributed to data analysis and interpretation, critical manuscript revision, and final approval of the version to be published.

SP contributed to critical manuscript revision and final approval of the version to be published.

DK contributed to the oversight of the study, data analysis and interpretation, critical manuscript revision, and final approval of the version to be published.

Funding

This research was funded by Department of Pediatrics at Cohen Children’s Medical Center of NY given to NZ.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 2013 Helsinki declaration.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was not available as the study was approved by the Institutional Review Board as a quality improvement study and informed consent was not needed.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatrics, Division of NeonatologyCohen Children’s Medical CenterNew Hyde ParkUSA
  2. 2.Feinstein Institute for Medical ResearchManhassetUSA
  3. 3.Hofstra University School of MedicineHempsteadUSA
  4. 4.Department of Pediatrics, Pediatric Critical Care DivisionCohen Children’s Medical CenterNew Hyde ParkUSA
  5. 5.Department of Pediatrics, Pediatric Radiology DepartmentCohen Children’s Medical CenterNew Hyde ParkUSA

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