A Prospective Observational Study to Assess the Utility of Ultrasound for Central Venous Catheter Tip Placement in Children

This prospective observational cohort study aims to evaluate the utility of ultrasound in accurately positioning central venous catheter (CVC) tips at the superior vena cava–right atrium (SVC-RA) junction in pediatric patients. Correct placement of the CVC tip is vital to avoid complications such as arrhythmias, valvular injury, or pericardial tamponade. Conventional methods such as chest radiography or insertion depth formulae are often limited by inaccuracy, radiation exposure, and procedural delays. Ultrasound, being real-time and radiation-free, has shown promise in adults, but there is limited data in pediatric populations. This study includes 30 children aged 0–12 years requiring CVC placement under anesthesia or sedation. Using sterile technique and Seldinger’s method, CVCs are inserted with ultrasound guidance, employing a subcostal bicaval view to visualize the SVC-RA junction and confirm catheter tip position. The rapid atrial swirl sign (RASS) is used to further confirm placement, and the quality of ultrasound visualization is graded. Initial insertion depth is calculated using height-based formulae and compared with ultrasound-confirmed depth and, where available, postoperative chest radiography using the tracheal bifurcation as a landmark. Parameters assessed include patient demographics, catheter specifications, insertion depth, visualization grade, guidewire position, RASS response, and radiographic tip location. Statistical analysis involves descriptive statistics, Pearson’s correlation, and Chi-square testing. The study seeks to establish whether ultrasound alone can ensure accurate CVC tip placement in pediatric patients, potentially reducing the need for confirmatory chest radiographs and enhancing patient safety by minimizing radiation exposure.