title: US-guided placement and tip position confirmation for lower-extremity central venous access in neonates and infants with comparison versus conventional insertion.
abstract: OBJECTIVE
  To describe experience with the use of ultrasound (US)-guided placement and tip position confirmation for direct saphenous and single-incision tunneled femoral noncuffed central venous catheters (CVCs) placed in neonates and infants at the bedside.
  
  
  METHODS
  A retrospective review of the interventional radiology (IR) database and electronic medical records was performed for 68 neonates and infants who received a CVC at the bedside and for 70 age- and weight-matched patients with CVCs placed in the IR suite between 2007 and 2012. Technical success, complications, and outcomes of CVCs placed at the bedside were compared with those in an age- and weight-matched sample of children with CVCs placed in the IR suite.
  
  
  RESULTS
  A total of 150 primary insertions were performed, with a technical success rate of 100%. Total catheter lives for CVCs placed at the bedside and in the IR suite were 2,030 catheter-days (mean, 27.1 d) and 2,043 catheter-days (mean, 27.2 d), respectively. No significant difference was appreciated between intraprocedural complications, mechanical complications (bedside, 1.53 per 100 catheter-days; IR, 1.76 per 100 catheter-days), or infectious complications (bedside, 0.39 per 100 catheter-days; IR, 0.34 per 100 catheter-days) between groups.
  
  
  CONCLUSIONS
  US-guided placement and tip position confirmation of lower-extremity CVCs at bedside for critically ill neonates and infants is a safe and feasible method for central venous access, with similar complications and catheter outcomes in comparison with CVCs placed by using fluoroscopic guidance in the IR suite.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104. Electronic address: gaballahm@email.chop.edu.
authors.forename: Marian
authors.initials: M
authors.lastname: Gaballah
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Krishnamurthy
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104.
authors.forename: Adeka
authors.initials: A
authors.lastname: McIntosh
authors.affiliation: Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104.
authors.forename: David A
authors.initials: DA
authors.lastname: Munson
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters; D004867:Equipment Design; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional