Use of Point of Care Ultrasound for Confirming Central Line Tip Position in Neonates

Preterm and sick term infants frequentlyrequire central venous access for provision of parenteral nutrition, infusionof inotropes and other drugs. Many infants in addition may requireinvasive central arterial canulation for blood pressure monitoring and repeatedblood sampling.Central lines in these infants are usuallyinserted and advanced blindly to a predetermined length based on an externalanatomic measurement of the estimated catheter pathway. Optimalityof catheter tip position is confirmed with chest or abdominal radiographs.Frequently, position of these catheters may be sub-optimal, necessitatingmanipulation of catheters followed by further radiographs for reconfirmation. This involves handling of critically ill infants and carries asignificant risk of dislodgement of lines, radiation exposure and unacceptabledelay in confirmation of central catheter position.

Point of care ultrasound (USG) is an emergingbedside tool in management of sick neonates. It may be used to locate catheterposition during and immediately after procedure, reducing the time lag andradiation exposure. Its usefulness in placement of central lines in adults andpaediatric patients is well established. There are few studiesthat have evaluated utility of USG in locating the tip position of centralcatheters in neonates.We plan to conduct this study to assessfeasibility of USG for evaluation of tip position of central catheter inneonates and to determine agreement between radiological and USG basedassessment of central line tip position.

Objectives:

1.      Toassess the feasibility of USGfor evaluation of tip position of central catheter in neonates.

2.      To determine agreement between radiologicaland USG based assessment of central line tip position.