Efficacy of Point Of Care Ultrasound in Detecting Central Line Tip Position in Neonates

Background: This study attempted to compare radiographic findings with that of the ultrasound in locating the central line tip and evaluate the agreement between these two diagnostic modalities.Methods: This hospital-based Prospective Observational Comparative Diagnostic Accuracy Test study was conducted on 51 neonates, in the NICU of a tertiary health care centre. A consecutive sampling technique was used for the neonates included in this study. The central catheter (umbilical vein catheter / peripherally inserted central catheter) was inserted. After the central line insertion, a thoracoabdominal X-ray was done to identify the catheter tip position as the standard protocol.  USG assessment of the central line tip position was also done.Results: Out of the 51 central lines studied, 49 were UVC and 2 were PICC line insertion. USG was able to identify all the malpositioned (n=38) and optimally placed central line tips (n=10) as in X-ray and also additionally identified the three doubtful tips on X-ray as malpositioned (n=1) and optimally placed (n=2). X-ray showed that 78.5% of UVCs were low lying and 66.6% were in intrahepatic IVC as identified by USG. Among the procedure-related complications, post X-ray more complications were noted, the most common being hypothermia.Conclusion: Our study results show that Point Of Care Ultrasound is a safer, more efficacious, and quick bedside diagnostic test compared to the conventional radiography in detecting central line tip position in neonates, helping pediatricians to quickly confirm the central line tip position before starting infusions.