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Published on: December 23, 2014
Defining central venous line position in children: tips for the tip
Giordano Perin1, Maria-Grazia Scarpa
1Paediatric Surgery and Urology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste - Italy.
Insights
Determining the optimal position for central venous catheters in children is challenging, as current methods lack reliability. Ultrasound and ECG show promise for safer, more cost-effective catheter tip assessment.
Area of Science:
- Medical Imaging
- Pediatric Critical Care
- Vascular Access
Background:
- Central venous catheters are crucial in pediatric care but require precise tip placement for efficacy and safety.
- Accurate assessment of catheter tip position is vital to prevent complications such as malposition, thrombosis, or infection.
Purpose of the Study:
- To review and analyze literature on the positioning of centrally inserted central venous catheters in children.
- To evaluate methods for assessing catheter tip position, including peripherally inserted central catheters (PICCs) and umbilical venous catheters.
Main Methods:
- Systematic analysis of 68 original manuscripts, with 42 focusing on pediatric populations and 26 on adults.
- Literature search encompassed publications from 1949 to 2014, primarily in English.
Main Results:
- Guidelines suggest optimal catheter tip placement between the superior vena cava and right atrium.
- While radiography and fluoroscopy are standard, no definitive landmark is recommended for pediatric populations.
- Ultrasonography has been explored for neonatal PICC placement, and electrocardiography (ECG) for general pediatric use.
Conclusions:
- Current evidence is insufficient for definitive recommendations on catheter tip positioning methods.
- Ultrasound and ECG techniques offer potential alternatives to chest X-ray, warranting further investigation.
- Wider adoption of these alternative methods could decrease radiation exposure and healthcare costs for pediatric patients.
Purpose:
The purpose of this study is to analyse literature related to the position of centrally inserted central venous catheters and to review topics related to assessment of tip position of those catheters in children. Applications of specific techniques to PICCs (Periferally Inserted Central Catheters) and umbilical venous catheter will also be reviewed.
Methods:
Analysis of 68 original manuscripts, 42 specifically related to the paediatric population, 26 related to the adult population. The papers analysed were published between 1949 and 2014; all articles were in English except one in Italian and one in German.
Results:
From the analysed literature, most of the guidelines recommend tip positioning at a level between the superior vena cava and the right atrium. Several methods have been described to evaluate tip position in the paediatric population, but none of those is considered completely reliable. The standard methods used to identify catheter tip position are radiography and fluoroscopy, but no specific landmark can be recommended in the paediatric population. The ultrasonographic approach has been investigated mainly for PICCs positioning in the neonatal population. The electrocardiographic method has been evaluated in the general paediatric population.
Conclusions:
No specific recommendation can be given due to the low level of evidence. Ultrasound and ECG (electrocardiogram) techniques are a potential alternative to chest X-ray and further studies should be implemented to establish them. A wider application of these techniques may reduce neonatal and paediatric exposure to radiations and additionally reduce costs.
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