POCUS using the neo-ECHOTIP protocol plus the retract, advance, and position (RAP) technique to improve lower...

Area of Science:

• Neonatal Medicine
• Medical Imaging
• Pediatric Surgery

Background:

• International guidelines advocate point-of-care ultrasonography (POCUS) in neonatology for various clinical applications.
• Standardized protocols for POCUS-guided confirmation of lower extremity catheter tip positioning remain limited.
• Accurate catheter tip placement is crucial for neonatal patient safety and effective treatment.

Purpose of the Study:

• To evaluate the efficacy of a novel "retract, advance, and position" (RAP) technique combined with the Neo-ECHOTIP (NE) protocol for confirming lower extremity central catheter tip placement in neonates.
• To compare the accuracy and efficiency of POCUS with the NE-SFT protocol alone versus the NE-SFT protocol with the added RAP technique.
• To assess the reduction in the need for post-procedural radiography for catheter tip verification.

Main Methods:

• A prospective study involving neonates receiving subcutaneously tunneled femorally inserted central catheters (ST-FICCs).
• Implementation of the Neo-ECHOTIP (NE) protocol with saline flush test (SFT) for initial catheter tip localization.
• Addition of a novel "retract, advance, and position" (RAP) technique to the NE-SFT protocol in a separate group.
• Verification of catheter tip position using two-view radiographs for all subjects.

Main Results:

• The NE-SFT + RAP group achieved 100% agreement with radiographic confirmation of catheter tip position, significantly higher than the 75% agreement in the NE-SFT group (p < 0.001).
• No malpositioned catheters were observed in the NE-SFT + RAP group, whereas 25% of catheters required repositioning in the NE-SFT group.
• The NE-SFT + RAP technique eliminated the need for repeat radiography, unlike the NE-SFT group which required 22 repeat radiographs (p < 0.0001).

Conclusions:

• The addition of the RAP technique to the Neo-ECHOTIP protocol significantly enhances the accuracy and ease of localizing lower extremity catheter tips in neonates.
• This POCUS-guided approach effectively eliminates the need for confirmatory radiography, streamlining the procedure and reducing radiation exposure.
• The NE-SFT + RAP technique represents a valuable advancement in neonatal procedural guidance and patient safety.