Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
J Perinatol. 2013 Oct;33(10):791-4. doi: 10.1038/jp.2013.58. Epub 2013 Jun 13.
The placement of a peripherally inserted central catheter (PICC) routinely incorporates tip position confirmation using standard radiographs. In this study, we sought to determine whether real-time ultrasound (RTUS) could be used to place a PICC in a shorter time period, with fewer manipulations and fewer radiographs than the use of radiographs to determine accurate placement.
This was a prospective, randomized, trial of infants who required PICC placement. Catheters were placed using either standard radiograph, with blinded evaluation of the catheters using RTUS or with RTUS guidance, with input on catheter tip location. The number of radiographs required to confirm proper positioning, duration of the procedure and manipulations of the lines were recorded for both groups. Final confirmation of PICC placement was by radiographs in both groups.
A total of 64 patients were enrolled in the study, with 16 failed PICC attempts. Of the 48 remaining infants, 28 were in the standard placement group and 20 were in the RTUS-guided group. The mean ± s.d. gestational ages and weight at time of placement were 30 ± 4 weeks and 1229 ± 485 g, respectively. The RTUS use significantly decreased the time of line placement by 30 min (P=0.034), and decreased the median number of manipulations (0 vs 1, P=0.032) and radiographs (1 vs 2 P=0.001) taken to place the catheters. Early identification of the PICC by RTUS was possible in all cases and would have saved an additional 38 min if radiographs were not required.
In the hands of ultrasound (US)-experienced neonatologists, RTUS-guided PICC placement reduces catheter insertion duration, and is associated with fewer manipulations and radiographs when compared with conventional placement.
外周静脉置入中心导管（PICC）的置管通常需要通过标准 X 光片确认尖端位置。在本研究中，我们旨在确定实时超声（RTUS）是否可以比使用 X 光片确定准确位置更快地放置 PICC，并且所需的操作和 X 光片数量更少。
这是一项前瞻性、随机临床试验，纳入需要 PICC 置管的婴儿。导管使用标准 X 光片或 RTUS 盲法评估或 RTUS 引导下放置，根据导管尖端位置输入信息。记录两组确认正确位置所需的 X 光片数量、手术持续时间和导管操作次数。两组均通过 X 光片确认 PICC 置管最终位置。
共有 64 名患者入组研究，其中 16 例 PICC 尝试失败。在其余 48 名婴儿中，28 名在标准置管组，20 名在 RTUS 引导组。两组的平均（±SD）胎龄和置管时体重分别为 30±4 周和 1229±485g。RTUS 的使用显著缩短了 30 分钟的置管时间（P=0.034），减少了中位数的操作次数（0 次与 1 次，P=0.032）和 X 光片数量（1 次与 2 次，P=0.001）。所有情况下均能通过 RTUS 早期识别 PICC，如不拍摄 X 光片，还可节省额外 38 分钟。
在有超声（US）经验的新生儿科医生手中，与传统置管相比，RTUS 引导下 PICC 置管可缩短导管插入时间，且所需操作和 X 光片数量更少。
