THE VALUE OF ULTRASOUND IN DETERMINING THE TIP POSITION OF PERIPHERALLY INSERTED CENTRAL CATHETERS IN NEONATES

Abstract

Objective: Central venous catheters are essential components in the treatment strategy for neonates, especially preterm and low birthweight infants. Incorrect positioning of the catheter tip can lead to life-threatening complications. Our study aimed to evaluate the effectiveness of using ultrasound to determine the position of peripherally inserted central catheter (PICC) tips in neonates, compared to X-ray as the diagnostic standard.

Methods: The cross-sectional study was conducted at the Neonatal Intensive Care Unit (NICU) of Children's Hospital 2, Ho Chi Minh City, from September 5, 2023, to May 31, 2024, involving 60 cases of PICC placement.

Results: We recorded 60 catheter placements, primarily in preterm and low birthweight infants (92.7%), with a median gestational age of 28 weeks (Q1-Q3: 26–31) and a median birthweight of 1,100 grams (Q1-Q3: 850–1,350). PICCs were placed in the upper extremity and head in 60% of cases, and in the lower extremity in 40%. The Kappa concordance coefficient between ultrasound and X-ray in determining PICC tip location was 0.87 (p <0.0001); with ultrasound assessment of the superior vena cava, the Kappa was 0.96 (p <0.0001); for the inferior vena cava, the Kappa was 0.72 (p <0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 88.9%, 93.9%, 92.3%, and 91.2%, respectively. For ultrasound assessment of the superior vena cava alone, these respective values were 100%, 95.7%, 92.9%, and 100%, while for the inferior vena cava, they were 78.6%, 90%, 91.7%, and 75%.

Conclusions: Ultrasound serves as a valuable adjunct to X-ray in determining the position of the PICC tip. It should be considered as the first-line option immediately following the procedure.

Keywords: central venous catheter; ultrasound