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Ultrasound and Radiography Evaluation of the Tips of Peripherally Inserted Central Catheters in Neonates Admitted to the Nicu Publisher



Kadivar M1, 2 ; Mosayebi Z1, 3 ; Ghaemi O2, 4 ; Sangsari R1, 2 ; Saeedi M1, 2 ; Shariat M3 ; Mehdizadeh M2, 5 ; Mohamadi S2, 6 ; Majnoon MT2 ; Mirnia K1, 2
Authors
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Authors Affiliations
  1. 1. Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
  3. 3. Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Division of Radiology, Shariati Hospital, Tehran, Iran
  5. 5. Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Division of Neonatology, Children’s Medical Center, Tehran, Iran

Source: Iranian Journal of Pediatrics Published:2020


Abstract

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 Chil-dren’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 methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests. Results: A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%. Conclusions: Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning. © 2020, Author(s).