经胸超声心动图用于儿童中心静脉导管尖端定位：一项以经食管超声心动图为参考方法的观察性研究
Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.
作者信息
Thomsen Kristen K, Fritz Michael, Zöllner Christian, Kessler Till, Saugel Bernd, Schulte-Uentrop Leonie
机构信息
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Outcomes Research Consortium, Houston, Texas, USA.
出版信息
Paediatr Anaesth. 2025 Apr;35(4):310-315. doi: 10.1111/pan.15059. Epub 2025 Jan 4.
BACKGROUND
Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.
AIMS
We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.
METHODS
This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.
RESULTS
150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).
CONCLUSION
TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.
TRIAL REGISTRATION
German Clinical Trial Register: DRKS00028271.
背景
需要进行大手术或患有重症的儿童通常需要插入中心静脉导管（CVC）。为避免严重并发症，将CVC尖端正确定位在远端上腔静脉与右心房交界处（腔房交界处）很重要。经胸超声心动图（TTE）可用于确认CVC尖端的正确位置。然而，TTE用于CVC尖端定位的准确性主要是通过胸部X线作为参考方法进行研究的——尽管胸部X线本身无法直接将CVC尖端定位在腔房交界处。
目的
我们旨在确定TTE是否有助于在儿童插入CVC期间将CVC尖端准确地定位在腔房交界处。我们特别检验了以下假设：在≥90%的儿童中，TTE引导的CVC尖端定位会使CVC尖端在腔房交界处处于正确位置（经食管超声心动图（TEE）作为参考方法确认）。
方法
这是一项针对计划进行先天性心脏病择期手术的0至14岁儿童的前瞻性观察性研究。我们的主要终点是经TEE确认，在TTE引导下CVC尖端在腔房交界处处于正确位置的儿童比例。
结果
对150名儿童进行了分析。TTE引导的CVC尖端定位使136名儿童（91%，95%置信区间：85%-94%）的CVC尖端在腔房交界处处于正确位置。TTE引导使CVC尖端在腔房交界处处于正确位置的儿童比例在0至3个月大的儿童中最高（96%），在13至14岁的儿童中最低（70%）。
结论
经TEE确认，在91%的儿童中，TTE引导的CVC尖端定位使CVC尖端在腔房交界处处于正确位置。临床医生在儿童插入CVC期间，尤其是年幼患儿，应考虑使用TTE将CVC尖端定位在腔房交界处。
试验注册
德国临床试验注册中心：DRKS00028271。
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