Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA, 98105, USA.
Pediatr Radiol. 2021 Jun;51(7):1253-1258. doi: 10.1007/s00247-020-04957-x. Epub 2021 Feb 5.
Ultrasonography may reliably visualize both appropriately positioned and malpositioned femoral-approach catheter tips. Radiography may be used to confirm catheter tip position after placement, but its utility following intraprocedural ultrasound (US) catheter tip verification is unclear.
To report the utility of confirmatory radiographs after US-guided tunneled femoral central venous catheter (CVC) placements by interventional radiology in pediatric patients.
A total of 484 pediatric patients underwent bedside US-guided tunneled femoral CVC placements in an intensive care setting at a single tertiary children's hospital between Jan. 1, 2016, and April 20, 2020. Technical success, adverse events, post-procedure radiographic practices and inter-modality catheter tip concordance were recorded. All radiographs were performed within 12 h of catheter placement.
The mean patient age was 175±508 days (range: 1 day to 19 years), including 257 (53.1%) males and 227 (46.9%) females. Of the 484 attempted placements, 472 (97.5%) were primary placements. Four hundred eighty-one (99.4%) placements were technically successful. There were three (0.6%) technical failures due to previously undiagnosed iliofemoral venous occlusive disease. Five (1.0%) adverse events occurred. Radiographs were obtained within 12 h of CVC placement in 171 (35.3%) patients, in 120 (70.2%) of whom the indication was recent catheter placement. All 171 (100%) post-placement radiographs showed catheter tip location concordance with the intra-procedural US. In one (0.2%) patient, in whom there was nonvisualization of a guidewire and clinical concern for malposition during US-guided placement, post-procedure radiographs, coupled with multiplanar venography, demonstrated inadvertent paravertebral venous plexus catheter placement.
The concordance between intra-procedural US and confirmatory post-procedure radiographs of CVC placements by interventional radiology obviates the need for routine radiographs. Radiographs may be obtained in instances of proceduralist uncertainty or clinical concern.
超声检查可可靠地显示适当定位和定位不当的股入路导管尖端。在放置后可以使用放射线照相术来确认导管尖端位置，但在经皮腔内超声（US）导管尖端验证后，其效用尚不清楚。
报告在小儿患者中，介入放射学进行的经超声引导的隧道式股静脉中央导管（CVC）放置后，确认性射线照相术的效用。
在 2016 年 1 月 1 日至 2020 年 4 月 20 日期间，在一家三级儿童医院的重症监护病房，共有 484 名儿科患者接受了床边超声引导的隧道式股静脉 CVC 放置。记录了技术成功率、不良事件、术后放射学实践和两种方法的导管尖端一致性。所有射线照相术均在导管放置后 12 小时内进行。
患者的平均年龄为 175±508 天（范围：1 天至 19 岁），包括 257 名（53.1%）男性和 227 名（46.9%）女性。在 484 次尝试放置中，有 472 次（97.5%）为初次放置。481 次（99.4%）放置技术成功。由于先前未诊断出的髂股静脉阻塞性疾病，有 3 次（0.6%）技术失败。有 5 次（1.0%）不良事件发生。在 171 名（35.3%）患者中，在 CVC 放置后 12 小时内获得了射线照相术，在 120 名（70.2%）患者中，最近的导管放置是获得射线照相术的指征。所有 171 次（100%）术后射线照相术均显示导管尖端位置与术中 US 检查一致。在 1 名（0.2%）患者中，在 US 引导下放置时，导丝不可见，临床怀疑导管位置不当，术后射线照相术与多平面静脉造影相结合，显示出导管意外地放置在椎旁静脉丛中。
介入放射学进行的 CVC 放置的术中 US 与确认性术后射线照相术之间的一致性使得常规射线照相术成为多余。在程序不确定性或临床关注的情况下，可以获得射线照相术。
