Research Rutgers, Robert Wood Johnson Medical School New Brunswick, New Jersey, United States
Background: Intravenous access via central catheters is essential in the care of the preterm infant in the NICU. Traditionally, confirmation of the line depth has determined by radiography with adjustments to place the catheter tip at the cavoatrial junction. While x-ray remains the most common method for central catheter imaging, it has inherent drawbacks producing only a single, still, flat image. As compared to radiographs, Point-of-Care-Ultrasonography (POCUS) displays dynamic, continuous real-time information without radiation exposure. POCUS has displayed better sensitivity, specificity, positive predictive value, and negative predictive value in identifying neonatal central catheter tips in comparison to radiographs. Objective: We hypothesize that the identification of central catheter tip placement with POCUS, will have a high level of agreement as compared to current standard of care, X-ray. Although many studies have focused on comparing the two, only a few have determined the degree of agreement between radiological and POCUS based assessment of the central line tip in the neonatal population. As a secondary objective, we aim to assess the time taken to identifying the central line tip through the two imaging modalities. Design/Methods: We have designed a prospective observational study in our 34-bed tertiary neonatal-ICU.The study was reviewed and approved by the research ethics board of our institution. Based on our eligibility criteria, parental consent was obtained prior to study enrolment. At any time, when a chest X-ray is obtained due to a clinical indication, a corresponding ultrasonographic images of the line tip is obtained by POCUS trained neonatologist . Ultrasound images are obtained within two hours of a radiograph to mitigate for the confounding of accidental line adjustment in between image acquisition. Imaging pairs shall subsequently be compared for line tip positioning and agreement will be determined by Kappa coefficient. Preliminary analysis has been promising with 93% of agreement achieved (n=13/14).
