Intracavitary electrocardiography-guided positioning of central vascular access device can spare unnecessary ionizing radiation exposure in pediatric patients

Abstract

Background:

Most hospital protocols—including those of our own institute—require the use of radiography to validate tip position in every central vascular access device placement. This study evaluated whether unnecessary ionizing radiation exposure could be spared in the pediatric population when intracavitary electrocardiography is used to guide catheter placement.

Material and methods:

Retrospective study of intracavitary electrocardiography-guided central vascular access device placements in our pediatric surgery department between 2013 and 2018. We evaluated the operating time, success in positioning the catheter, and accuracy of final tip position. We also assayed the effects of catheter type and of catheter access point on operating time, success, accuracy, and complications. We applied the chi-square test for statistical analysis.

Results:

In total, 622 interventions of central vascular access device placements were evaluated; 340 intracavitary electrocardiography-guided central vascular access device placements were included in the study. The electrocardiography method successfully positioned the tip of the catheter in 316/340 (92.94%) of placements. Where intracavitary electrocardiography placement was successful, radiography confirmed accuracy of tip position in 314/316 (99.41%) of placements.

Conclusion:

When electrocardiography-guided positioning is uneventful and a valid P-Wave pattern is seen, postprocedure radiograph imaging for verification is unnecessary. Any effort should be made to upgrade hospital policies according to evidences and newest guidelines to spare pediatric patients harmful exposure to radiation by limiting the use of radiography only to selected cases.

Keywords

Central vascular access device children ECG-guided positioning radiography ultrasound

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References

Barczykowska

Szwed-Kolinska

Wrobel-Bania

, et al. The use of central venous lines in the treatment of chronically ill children. Adv Clin Exp Med 2014; 23(6): 1001–1009.

Jöhr

Berger

. Venous access in children: state of the art. Curr Opin Anaesthesiol 2015; 28(3): 314–320.

Parigi

Verga

. Accurate placement of central venous catheters in pediatric patients using endocavitary electrocardiography: reassessment of a personal technique. J Pediatr Surg 1997; 32(8): 1226–1228.

Gorski

Hadaway

Hagle

, et al. Infusion therapy standards of practice. J Infus Nurs 2016; 39(1S): S46–S47.

Kleinerman

. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 2006; 36(Suppl. 2): 121–125.

Watters

Grant

. Use of electrocardiogram to position right atrial catheters during surgery. Ann Surg 1997; 225(2): 165–171.

Serafini

Pietrobono

Cornara

. Location of central venous catheters in children by endocavitary ECG: a new technique. Clin Nutr 1985; 4(4): 201–202.

Hoffman

Langer

Pearl

, et al. Central venous catheters—no X-rays needed: a prospective study in 50 consecutive infants and children. J Pediatr Surg 1988; 23(12): 1201–1203.

Redo

Dinner

. Placement of central venous catheters by cut-down with electrocardiogram positioning. Surg Gynecol Obstet 1993; 177(1): 49–53.

10.

Haußer

. Klinische Anwendung eines neuen cava-katheters mit EKG-ableitung über stahlmandrin. Der Anesthesist 1990; 39: 240–242.

11.

Simon

Teboul

Gwinner

, et al. Central venous catheter placement in children: evaluation of electrocardiography using J-wire. Paediatr Anaesth 1999; 9(6): 501–504.

12.

Neubauer

. Central venous placement of silastic catheters by recording of an intravascular ECG—a prospective study in 50 premature infants weighing less than 1000 g. Klin Padiatr 1991; 203(3): 146–148.

13.

Rossetti

Pittiruti

Lamperti

, et al. The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study. J Vasc Access 2015; 16(2): 137–143.

14.

Andrew

David

Adams

, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994; 83(5): 1251–1257.

15.

Salmela

Aromaa

Verification of the position of a central venous catheter by intra-atrial ECG. When does this method fail?

Acta Anaesthesiol Scand 1993; 37(1): 26–28.

16.

Schummer

Herrmann

Schummer

, et al. Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters. Br J Anaesth 2003; 91(4): 481–486.

17.

Kremser

Kleemann

Reinhart

, et al. Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance. Br J Anaesth 2011; 107(4): 567–572.

18.

Perin

Scarpa

. Defining central venous line position in children: tips for the tip. J Vasc Access 2015; 16(2): 77–86.

19.

Smit

Raadsen

Blans

, et al. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Crit Care 2018; 22(1): 65.

20.

Alonso-Quintela

Oulego-Erroz

Rodriguez-Blanco

, et al. Location of the central venous catheter tip with bedside ultrasound in young children: can we eliminate the need for chest radiography. Pediatr Crit Care Med 2015; 16(9): e340–e345.