Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants

Abstract

The use of plain radiographs provides limited information on the placement of peripherally inserted central catheters (PICCs). Moreover, changes in upper extremity positioning cause migration of the catheters in neonates. This study aimed to investigate the use of echocardiography for determining catheter tip position, compared with plain radiographs, in low birthweight (LBW) infants in a tertiary neonatal intensive care unit. The study examined the placement of 109 catheters in 89 infants born between September 2010 and December 2012. The placement of these catheters was controlled by echocardiography, with the patient's shoulder in adduction and the elbow in flexion. The number of catheter tips, echocardiographically identified within the heart, was expressed as a percentage of the total catheters deemed to be well positioned on plain radiographs. The number of catheter tips that were echocardiographically identified within the heart was significant (25%, p < 0.001). Twenty-three catheters were repositioned to be outside of the heart, without any complications. This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.