Baehner Torsten, Rohner Marc, Heinze Ingo, Schindler Ehrenfried, Wittmann Maria, Strassberger-Nerschbach Nadine, Kim Se-Chan, Velten Markus
St. Nikolaus-Stiftshospital Andernach, Ernestus-Platz 1, 56626 Andernach, Germany.
Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
J Clin Med. 2021 Dec 20;10(24):5971. doi: 10.3390/jcm10245971.
Central venous catheters (CVC) are commonly required for pediatric congenital cardiac surgeries. The current standard for verification of CVC positioning following perioperative insertion is postsurgical radiography. However, incorrect positioning may induce serious complications, including pleural and pericardial effusion, arrhythmias, valvular damage, or incorrect drug release, and point of care diagnostic may prevent these serious consequences. Furthermore, pediatric patients with congenital heart disease receive various radiological procedures. Although relatively low, radiation exposure accumulates over the lifetime, potentially reaching high carcinogenic values in pediatric patients with chronic disease, and therefore needs to be limited. We hypothesized that correct CVC positioning in pediatric patients can be performed quickly and safely by point-of-care ultrasound diagnostic.
We evaluated a point-of-care ultrasound protocol, consistent with the combination of parasternal craniocaudal, parasternal transversal, suprasternal notch, and subcostal probe positions, to verify tip positioning in any of the evaluated views at initial CVC placement in pediatric patients undergoing cardiothoracic surgery for congenital heart disease.
Using the combination of the four views, the CVC tip could be identified and positioned in 25 of 27 examinations (92.6%). Correct positioning was confirmed via chest X-ray after the surgery in all cases.
In pediatric cardiac patients, point-of-care ultrasound diagnostic may be effective to confirm CVC positioning following initial placement and to reduce radiation exposure.
小儿先天性心脏手术通常需要中心静脉导管（CVC）。围手术期插入CVC后，目前验证其位置的标准是术后影像学检查。然而，位置不正确可能会引发严重并发症，包括胸腔和心包积液、心律失常、瓣膜损伤或药物释放错误，而即时诊断可能会避免这些严重后果。此外，患有先天性心脏病的儿科患者会接受各种放射学检查。虽然辐射暴露相对较低，但会在一生中累积，在患有慢性病的儿科患者中可能达到高致癌值，因此需要加以限制。我们假设通过即时超声诊断可以快速、安全地确定儿科患者CVC的正确位置。
我们评估了一种即时超声方案，该方案结合了胸骨旁头侧尾侧、胸骨旁横向、胸骨上切迹和肋下探头位置，以在接受先天性心脏病心胸手术的儿科患者初次放置CVC时，在任何评估视图中验证尖端位置。
使用这四种视图的组合，在27次检查中的25次（92.6%）中可以识别并定位CVC尖端。所有病例术后均通过胸部X线证实位置正确。
对于小儿心脏患者，即时超声诊断可能有助于在初次放置CVC后确认其位置，并减少辐射暴露。
