Saul David, Ajayi Samuel, Schutzman David L, Horrow Mindy M
Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania USA.
Department of Pediatrics, Einstein Medical Center, Philadelphia, Pennsylvania USA.
J Ultrasound Med. 2016 Jul;35(7):1465-73. doi: 10.7863/ultra.15.06104. Epub 2016 May 26.
Neonates in the neonatal intensive care unit often require considerable support with endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. Support device evaluation with radiography exposes neonates to ionizing radiation. This study evaluated the effectiveness of sonographic localization for endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters.
This blinded prospective Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study with informed consent compared sonography to radiography for endotracheal tube, umbilical arterial and venous catheter, and peripherally inserted central venous catheter localization. Participants were consecutively recruited NICU patients of any weight, gestation, and chronologic age who had an endotracheal tube, umbilical arterial catheter, umbilical venous catheter, or peripherally inserted central venous catheter placed or adjusted and had subsequent radiographic confirmation within 24 hours. Sonographic evaluation was obtained as soon as possible, without prior review of the radiograph, and results were compared.
Thirty sonographic studies were performed in 25 patients (14 male and 11 female), for a total of 50 lines and tubes: 18 umbilical venous catheters, 12 umbilical arterial catheters, 11 peripherally inserted central venous catheters, and 9 endotracheal tubes. Forty-nine support devices (98%) were visualized with sonography, all concordant with radiography. Forty-four were correctly positioned, and 6 were malpositioned. Sonography identified the location of umbilical venous catheters in all 18 cases (100%), umbilical arterial catheters in all 12 (100%), peripherally inserted central venous catheters in 10 (91%), and endotracheal tubes in 9 (100%).
The effectiveness of sonography was excellent for evaluation of umbilical arterial and venous catheters, endotracheal tubes, and peripherally inserted central venous catheters. These results support the goal of further point-of-care training and accreditation to use sonography as a primary modality for complete evaluation of NICU support devices.
新生儿重症监护病房的新生儿常常需要借助气管内导管、脐动脉和静脉导管以及外周静脉穿刺中心静脉导管来获得大量支持。通过放射成像对支持装置进行评估会使新生儿暴露于电离辐射之下。本研究评估了超声定位在气管内导管、脐动脉和静脉导管以及外周静脉穿刺中心静脉导管方面的有效性。
这项经机构审查委员会批准的、符合《健康保险流通与责任法案》且获得知情同意的前瞻性盲法研究，将超声检查与放射成像用于气管内导管、脐动脉和静脉导管以及外周静脉穿刺中心静脉导管定位进行了比较。连续招募任何体重、孕周和实际年龄的新生儿重症监护病房患者，这些患者已放置或调整了气管内导管、脐动脉导管、脐静脉导管或外周静脉穿刺中心静脉导管，并在24小时内进行了后续放射成像确认。在不预先查看放射影像的情况下尽快进行超声评估，并对结果进行比较。
对25例患者（14例男性和11例女性）进行了30次超声检查，共计50根导管和管子：18根脐静脉导管、12根脐动脉导管、11根外周静脉穿刺中心静脉导管和9根气管内导管。超声检查显示49个支持装置（98%），所有结果均与放射成像一致。44个位置正确，6个位置不当。超声检查在所有18例（100%）中确定了脐静脉导管的位置，在所有12例（100%）中确定了脐动脉导管的位置，在10例（91%）中确定了外周静脉穿刺中心静脉导管的位置，在9例（100%）中确定了气管内导管的位置。
超声检查在评估脐动脉和静脉导管、气管内导管以及外周静脉穿刺中心静脉导管方面效果极佳。这些结果支持了进一步开展即时护理培训和认证的目标，即将超声检查作为全面评估新生儿重症监护病房支持装置的主要方式。
