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The reliability of 2D and colour Doppler ultrasound in localising longline position
Carl A Kuschel1, Kitty P Bach, Nicola J Webster
1Newborn Services, National Women's Health, Auckland District Health Board, Auckland, New Zealand.
Insights
Cardiac ultrasound can help confirm the position of central venous catheters (longlines) in neonates. However, its effectiveness depends on operator experience and complements, but does not replace, traditional radiography.
Area of Science:
- Neonatal care
- Pediatric cardiology
- Medical imaging
Background:
- Percutaneously inserted central venous catheters (longlines) are critical in neonates.
- Malpositioned longlines can lead to fatal complications.
Purpose of the Study:
- To evaluate the utility of cardiac ultrasound (2D and color Doppler) for assessing neonatal longline position.
- To compare ultrasound findings with contrast radiography.
Main Methods:
- Echocardiography (2D and color Doppler) was performed by novice and experienced operators on 44 neonates with longlines.
- Longline position was also determined by two independent observers using contrast radiography.
Main Results:
- 2D echocardiography identified 41% (novice) and 59% (experienced) of longlines; agreement between operators was only 53%.
- Color Doppler improved the experienced operator's success but not the novice's.
- Radiography showed 68% agreement; however, echocardiography revealed 7% of longlines were within the heart, misidentified by radiography.
Conclusions:
- Cardiac ultrasound for neonatal longline assessment is experience-dependent.
- It serves as a complementary tool to contrast radiography, not a replacement.
- Echocardiography can identify some longlines within the heart that appear acceptable on radiography.
Background:
The position of percutaneously inserted central venous catheters (longlines) in neonates is critical, as malpositioned longlines are associated with potentially fatal complications.
Aim:
To determine if cardiac ultrasound (two-dimensional (2D) and colour Doppler) is useful in evaluating longline position, when compared with the position identified by contrast radiography.
Setting:
Single level 3 neonatal unit.
Participants:
Forty-four neonates undergoing insertion of 24-gauge silastic longlines between July 2004 and September 2005.
Methods:
Infants who had a longline inserted underwent echocardiography by a novice and an experienced operator. Operators identified longline position using a 2D then colour Doppler echocardiography during a rapid bolus infusion of saline. The position was identified from contrast radiography by two independent observers.
Results:
Using 2D echocardiography, the novice and experienced operators could identify 41 and 59% of longlines, respectively. However, only 34% of longlines were identified by both operators. In 15 infants whose longline positions were identified by both operators, there was agreement in only eight infants (53%). Colour Doppler improved the experienced operator's success but did not assist the novice operator. For radiographs, there was 68% agreement on longline position between observers. The experienced echocardiographer located three (7%) longlines within the heart that from radiographs were thought to be in a proximal central vessel.
Conclusions:
This technique is experience-dependent and complements rather than replaces the use of contrast radiography. However, some infants with an apparently acceptable longline position on contrast radiography have longlines located within the heart on echocardiography.
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