title: Sonography for Complete Evaluation of Neonatal Intensive Care Unit Central Support Devices: A Pilot Study.
abstract: OBJECTIVE
  Neonates in the neonatal intensive care unit often require considerable support with endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. Support device evaluation with radiography exposes neonates to ionizing radiation. This study evaluated the effectiveness of sonographic localization for endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters.
  
  
  METHODS
  This blinded prospective Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study with informed consent compared sonography to radiography for endotracheal tube, umbilical arterial and venous catheter, and peripherally inserted central venous catheter localization. Participants were consecutively recruited NICU patients of any weight, gestation, and chronologic age who had an endotracheal tube, umbilical arterial catheter, umbilical venous catheter, or peripherally inserted central venous catheter placed or adjusted and had subsequent radiographic confirmation within 24 hours. Sonographic evaluation was obtained as soon as possible, without prior review of the radiograph, and results were compared.
  
  
  RESULTS
  Thirty sonographic studies were performed in 25 patients (14 male and 11 female), for a total of 50 lines and tubes: 18 umbilical venous catheters, 12 umbilical arterial catheters, 11 peripherally inserted central venous catheters, and 9 endotracheal tubes. Forty-nine support devices (98%) were visualized with sonography, all concordant with radiography. Forty-four were correctly positioned, and 6 were malpositioned. Sonography identified the location of umbilical venous catheters in all 18 cases (100%), umbilical arterial catheters in all 12 (100%), peripherally inserted central venous catheters in 10 (91%), and endotracheal tubes in 9 (100%).
  
  
  CONCLUSIONS
  The effectiveness of sonography was excellent for evaluation of umbilical arterial and venous catheters, endotracheal tubes, and peripherally inserted central venous catheters. These results support the goal of further point-of-care training and accreditation to use sonography as a primary modality for complete evaluation of NICU support devices.
authors.affiliation: Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania USA.
authors.forename: David
authors.initials: D
authors.lastname: Saul
authors.affiliation: Department of Pediatrics, Einstein Medical Center, Philadelphia, Pennsylvania USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ajayi
authors.affiliation: Department of Pediatrics, Einstein Medical Center, Philadelphia, Pennsylvania USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Schutzman
authors.affiliation: Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania USA horrowm@einstein.edu.
authors.forename: Mindy M
authors.initials: MM
authors.lastname: Horrow
mesh_terms: D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011446:Prospective Studies; D016037:Single-Blind Method; D018084:Ultrasonography, Interventional / Q000379:methods*; D014471:Umbilical Veins / Q000000981:diagnostic imaging; D062666:Vascular Access Devices
keywords: central venous catheter; endotracheal tube; neonate; pediatric ultrasound; sonography