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Published on: December 23, 2014
Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using
Kristen K Thomsen1,2, Michael Fritz1, Christian Zöllner1
1Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Transthoracic echocardiography (TTE) successfully guided central venous catheter (CVC) tip placement in 91% of pediatric patients, ensuring optimal positioning at the cavoatrial junction. This method is particularly effective in younger children, improving CVC safety during critical care.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular imaging
- Interventional cardiology
Background:
- Central venous catheter (CVC) insertion is critical for critically ill children but requires precise tip placement at the cavoatrial junction to prevent complications.
- Transthoracic echocardiography (TTE) is a potential tool for confirming CVC tip position, but its accuracy has been limited by comparisons to chest X-ray, which cannot directly visualize the cavoatrial junction.
Purpose of the Study:
- To evaluate the efficacy of TTE in guiding the precise positioning of CVC tips at the cavoatrial junction during insertion in pediatric patients.
- To test the hypothesis that TTE-guided CVC placement achieves correct positioning in at least 90% of cases, verified by transesophageal echocardiography (TEE).
Main Methods:
- A prospective observational study involving 150 children (0-14 years) undergoing elective surgery for congenital heart disease.
- TTE was used to guide CVC tip placement, with the final position confirmed by TEE as the reference standard.
Main Results:
- TTE guidance resulted in correct CVC tip positioning at the cavoatrial junction in 136 out of 150 children (91% accuracy).
- Accuracy was highest in infants aged 0-3 months (96%) and lowest in adolescents aged 13-14 years (70%).
Conclusions:
- TTE-guided CVC tip positioning is highly accurate (91%), confirmed by TEE, for pediatric patients.
- TTE is a valuable tool for ensuring correct CVC tip placement in children, especially in younger age groups.
Background:
Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.
Aims:
We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.
Methods:
This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.
Results:
150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).
Conclusion:
TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.
Trial Registration:
German Clinical Trial Register: DRKS00028271.
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