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Central venous catheter motion: a pitfall in catheter localization on pediatric chest radiography
1Department of Radiology, The University of Alabama at Birmingham, 35233, USA.
Insights
Central venous catheter motion can lead to incorrect tip location assessment on pediatric chest X-rays. This study demonstrates how motion artifacts can mimic catheter displacement or removal, impacting patient management.
Area of Science:
- Radiology
- Pediatric Imaging
- Medical Devices
Background:
- Accurate central venous catheter (CVC) tip placement is crucial for effective treatment and preventing complications.
- Motion artifact on radiographic imaging can obscure or misrepresent the true position of medical devices.
Purpose of the Study:
- To evaluate the impact of central venous catheter motion on the interpretation of catheter tip location in pediatric patients.
- To investigate the potential for motion artifacts to cause misinterpretation of CVC tip position using an experimental model.
Main Methods:
- A prospective study of chest radiographs in pediatric and neonatal emergency departments was conducted over 2 months.
- An in vitro model was developed to replicate clinical parameters and analyze catheter movement and exposure time.
- Radiographs were examined for changes in CVC tip position attributed to motion artifact.
Main Results:
- In a cohort of 12 patients, catheter motion led to minor to major misinterpretations of CVC tip location, including nonvisualization.
- Similar findings were observed in 3.5% of 352 prospectively interpreted pediatric emergency department radiographs.
- In vitro experiments successfully reproduced catheter motion-induced blurring using standard clinical radiographic parameters.
Conclusions:
- Catheter motion is a significant factor that can compromise the accurate assessment of CVC tip position on pediatric emergency department chest radiographs.
- This artifact can falsely suggest catheter removal or repositioning, potentially leading to altered patient management decisions.
- Both catheter motion and radiographic exposure time were identified as key factors affecting catheter localization in this study.
Objective:
We evaluated central venous catheter motion causing misinterpretation of catheter tip location in pediatric patients and in an experimental model.
Materials And Methods:
After the recognition of clinically significant catheter motion in 12 randomly selected patients, we conducted a prospective 2-month study of chest radiographs in our pediatric care unit and neonatal emergency department. Serial radiographs were examined for change in catheter tip position ascribed to motion artifact. An in vitro model was developed to replicate clinical parameters. Experimentally, catheter movement and exposure time were analyzed and their impact on catheter localization was recorded.
Results:
In the 12 randomly selected patients, radiographic assessment of central venous catheter tip localization on sequential radiographs caused minor to major misinterpretation of the position of the catheter tip and even total nonvisualization of the catheter. Ten (3.5%) of 352 prospectively interpreted pediatric emergency department radiographs showed similar findings. Catheter motion that caused blurring was reproduced in vitro using radiographic parameters typically used in a clinical setting.
Conclusion:
Catheter motion can cause problems in assessing catheter tip position on pediatric emergency department chest radiographs. We reproduced this phenomenon in an in vitro model. Catheter removal or change in position may be mimicked by this artifact, and patient management may be affected. In our study, catheter localization was affected by catheter motion and exposure time.