Radiology Department,Medical School, Shiraz University Of Medical Siences, Shiraz, Iran
Assistant Professor, Neonatal Research Center, Shiraz University Of Medical Siences ,Shiraz ,Iran
Vascular access has become a very important aspect of care for neonates. The use of peripherally inserted central venous catheters (PICCs) has become common in recent years. Therefore, the aim of study is to evaluate the accurate position of PICCs tip by ultrasound.
This cross-sectional study was done on neonates admitted to NICU of hospitals affiliated to Shiraz University of medical sciences of Iran from March 2015 to March 2016. All neonates requiring PICCs due to prematurity or other diseases were entered into this study and 296 newborns had criteria for entering the study. In this study, we used catheter from Vygon Company, PICC was inserted at the patient’s bedside based on sterile conditions and NICU protocol. The neonatal PICC has a tip that terminates at or close to the heart or in one of the great vessels (the superior vena cava or the inferior vena Cava). Chest x ray results were recorded in the form and then, ultrasound results were performed blindly and without knowledge of Chest x ray results by a radiologist to examine the tip of the PICC line. It should be noted that written, informed consent was taken from their parents before this study.
The sensitivity and spicifity of ultrasound for location of catheter tip position in the superior vena cava is 98% and 96.6% respectively, and positive predictive value and negative predictive value is 96.2 % and 98.3% respectively. The sensitivity and spicifity of chest x ray for correct length of catheter that placed in correct position was 78% and 68.5% repectively.
Our study suggest that ultrasound is the more reliable and safe than chest x ray for the identification of the PICCs position and also detects complication of catheter malposition earlier, and reducing exposure ionization radiation.