Digital imaging does not improve localization of percutaneously inserted central lines in neonates.
OBJECTIVE
To determine whether the use of digital imaging improves the localization of percutaneously inserted central (PIC) line tips compared to standard radiographs, with contrast being used in both cases.


METHODS
Digital radiographs taken for localization of PIC lines between October 2002 and September 2003 were identified from the neonatal database. Two reporters independently reviewed the radiographs and stated (i) whether the tip could confidently be seen and (ii) the position. The observers were encouraged to use all the image modification modalities available. The formal radiology report was taken as the third 'reporter'.


RESULTS
Overall 117 digital radiographs from 98 infants were reviewed. Reporter 1 identified the tip in 83 (71%); reporter 2 in 84 (72%); and the radiologist in 95 (81%), although all agreed that the tip could be identified in only 55 (47%) radiographs. In radiographs where the reporters agreed that the tip could be identified, they agreed on the position in 37 (67%) cases. In 61 (52%) radiographs the reporters did not agree that the tip could be seen, but they agreed on its position in 36 (59%) cases. The kappa coefficient for agreement on line position was 0.63. The level of agreement between reporters in this study using digital imaging was not significantly different from our previous findings using standard radiography with contrast (74/117, 63% vs 57/96, 59%).


CONCLUSIONS
The use of digital imaging, with its ability to manipulate images in order to identify PIC line tips, is not significantly better than using standard radiography with contrast.
Webster
Nicola J
NJ
Newborn Services, National Women's Hospital, Auckland, New Zealand.
Page
Bernadette
B
Kuschel
Carl A
CA
Battin
Malcolm R
MR
D000279:Administration, Cutaneous; D002405:Catheterization, Central Venous; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D009520:New Zealand; D011856:Radiographic Image Enhancement / Q000379:methods*; D011873:Radiology Information Systems