Tejopratap Oleti1, M Jeeva Sankar1, Anu Thukral2, V Sreenivas3, Arun Kumar Gupta4, Ramesh Agarwal1, Ashok K Deorari1, Vinod K Paul1. 1. Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. 2. Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. dranuthukral@gmail.com. 3. Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. 4. Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Abstract
OBJECTIVE: The aim of the study was to evaluate the incidence of peripheral inserted central catheter (PICC) tip malposition when the catheter is inserted under real-time ultrasound (RTUS) guidance when compared with conventional landmark (CL) technique in neonates. Additional objectives were to evaluate the PICC longevity and central line associated blood stream infections (CLABSI). STUDY DESIGN: In this randomised controlled trial, neonates were randomised to 'RTUS' (n = 40) or 'CL' (n = 40) groups. PICC tip was placed under ultrasound guidance in lower third of superior vena cava in the RTUS group. In 'CL' group, PICC was inserted as calculated by anatomical landmarks. RESULTS: The birth weight (1286 (926, 1662) vs. 1061 (889, 1636) g) and gestation (31.12 (3.1) vs. 31.4 (3.6) wks) were comparable among the groups. RTUS guidance during PICC insertion reduced incidence of tip malposition by 52% (67.5 vs. 32.5%; RR: 0.48; 95% CI: 0.29-0.79). The longevity of PICC and episodes of CLABSI were however similar in the two groups. CONCLUSIONS: Real-time ultrasound guidance during PICC placement reduces the incidence of tip malposition.
RCT Entities:
OBJECTIVE: The aim of the study was to evaluate the incidence of peripheral inserted central catheter (PICC) tip malposition when the catheter is inserted under real-time ultrasound (RTUS) guidance when compared with conventional landmark (CL) technique in neonates. Additional objectives were to evaluate the PICC longevity and central line associated blood stream infections (CLABSI). STUDY DESIGN: In this randomised controlled trial, neonates were randomised to 'RTUS' (n = 40) or 'CL' (n = 40) groups. PICC tip was placed under ultrasound guidance in lower third of superior vena cava in the RTUS group. In 'CL' group, PICC was inserted as calculated by anatomical landmarks. RESULTS: The birth weight (1286 (926, 1662) vs. 1061 (889, 1636) g) and gestation (31.12 (3.1) vs. 31.4 (3.6) wks) were comparable among the groups. RTUS guidance during PICC insertion reduced incidence of tip malposition by 52% (67.5 vs. 32.5%; RR: 0.48; 95% CI: 0.29-0.79). The longevity of PICC and episodes of CLABSI were however similar in the two groups. CONCLUSIONS: Real-time ultrasound guidance during PICC placement reduces the incidence of tip malposition.