Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates – A Prospective Diagnostic Evaluation study

Article type: Research Article

Authors: Shabeer, M.P.^a | Abiramalatha, T.^{a; d} | Gibikote, S.^b | Rebekah, G.^c | Thomas, N.^{a; *}

Affiliations: [a] Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India | [b] Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India | [c] Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India | [d] Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India

Correspondence: [*] Address for correspondence: Dr. Niranjan Thomas, Professor, Department of Neonatology, Christian Medical College, Vellore - 632004; Tamil Nadu; India. Tel.: +91 0416 2273311, Fax: +91 0416 2232035/2232103 E-mail: [email protected].

Abstract: OBJECTIVE:To evaluate the diagnostic accuracy and utility of bedside ultrasound (US) by neonatology residents to confirm position of umbilical venous catheter (UVC), umbilical arterial catheter (UAC), and peripherally inserted central catheter (PICC). METHODS:In this prospective study, we included neonates who required UVC, UAC or PICC insertion. Two neonatology residents performed all bedside US examinations after a short period of training. Plain radiograph was taken as gold standard. Time taken for confirmation of catheter position by US and radiograph was recorded. RESULTS:We recruited 71 neonates for UVC and UAC, and 40 neonates for PICC. Sensitivity and specificity of US in identifying a malpositioned catheter was good for UVC (94% and 66.7% respectively) and UAC (86.7% and 94.5%). Agreement between radiograph and US was good for UVC [0.718 (0.512, 0.861); p < 0.001] and UAC [0.857 (0.682, 0.953); p < 0.001]. Sensitivity (47.8%) of US in identifying a malpositioned PICC was low, though specificity (82.4%) was good. Agreement between radiograph and US in identifying PICC position was poor [0.25 (–0.084, 0.545); p 0.024]. This was due to incorrect interpretation of catheter position on radiograph in some infants, which was confirmed by the radiologist. The median time taken for US was significantly less than time taken for radiograph in confirming the position of UVC (50 vs. 155 minutes; p < 0.001)), UAC (45 vs. 128 minutes; p < 0.001), and PICC (60 vs. 136 minutes; p < 0.001). CONCLUSION:US examination byneonatology residents has good diagnostic accuracy in confirming the position of UAC and UVC, and possibly PICC in neonates. The time taken to confirm catheter position by US is significantly less than radiograph.

Keywords: Point of care sonography, neonatology residents, umbilical venous catheter, umbilical arterial catheter, peripherally inserted central catheter

DOI: 10.3233/NPM-200409

Journal: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 1, pp. 101-107, 2021