In many studies scan was performed by paediatric radiologists or cardiologists that are not always available or on-call, but recent studies have suggested that training on the use of real-time US (RUS) is easy and feasible. ĭespite all these proven advantages, US is still not widely used in many NICUs to assess the UVC tip position, possibly because it needs additional and adequate training of the medical staff. US also allows monitoring the UVC tip position over time, since tip migration has been described up to 50–90% of the cases. US can be performed at the bedside during the insertion procedure (real-time US,) avoiding multiple catheter manipulations and allowing an immediate and safe injection of fluids and medications. On the other hand ultrasonography (US) has been suggested in several papers as gold standard as it seems more reliable, faster and without side effects. Īntero-posterior chest radiography (CR) is the most commonly used method to locate catheter tip using as landmarks either the thoracic vertebral bodies or cardiac silhouette although a significant number of studies has questioned the accuracy of CR for this purpose. This position has been associated with less incidence of early and belated life-threatening complications such as pericardial and pleural effusion, cardiac tamponade, endocarditis, cardiac arrhythmias, liver haematoma, necrosis or other parenchymal injuries, necrotizing enterocolitis, thrombosis and portal hypertension. The ideal UVC tip position is outside the heart at the junction of inferior vena cava (IVC) and right atrium (RA). The UVC is usually inserted by skilled medical staff at a distance previously calculated using anthropometric measures or formulas and nomograms usually based on birth weight (BW). It is very easy to place, more stable when compared to a peripheral venous line and suitable for preterm and critically ill term infants who require fluids, inotropes, parenteral nutrition or frequent blood sampling. The umbilical venous catheter (UVC) is currently one of the most common central venous access devices used in neonatal intensive care unit (NICU).
Real-time ultrasound is easily teachable, increases the number of umbilical venous catheters placed in a correct position, reduces the number of line manipulations and the need of chest-x-rays. ConclusionĪ multimodal, targeted training on the use of real-time ultrasound for umbilical venous catheter placement is feasible.
Twenty-two catheters were also evaluated with serial scans during the intervention phase to assess migration rate which was 50%.
After the training the tip of the catheters was more frequently placed at the junction of the inferior vena cava and right atrium (75% vs 30.7%, p = 0.0023). The use of real-time ultrasound for tip location significantly increased after the training program (15.3% vs 89.2%, p < 0.0001). Resultsįifty-four patients were enrolled. Primary outcome was the percentage in the use of real-time ultrasound. MethodsĪ pre/post interventional study was carried out in our tertiary neonatal intensive care unit centre to evaluate the efficacy of a training protocol in the use of real-time ultrasound. So far, training programs are not well established. Ozone was measured at baseline to be 0.000 parts per million and 0.000 parts per million when read immediately after bulb sources were run for 40 minutes.Recent guidelines advocate the use of real-time ultrasound to locate umbilical venous catheter tip. To reach a minimum of 1000 mJ/cm 2 to the lateral aspects of the respirator, the exposure times required an increase to 1950 seconds. There was a large gradient in the measured dose compared with the perceived dose based on UV intensity labels. The least-exposed location on the rack was 68.5 cm from the base, column 3, mask position 4A. The inner mask exposure range was between 66% and 107% compared with the central convex position 3A.
Of the 4 locations measured for mask contouring effect, rack height 68.5 cm, column 3 showed the largest exposure dose gradient, with a minimum of 34% and a maximum of 126% compared with the central convex position 3A. This confirmed a dose gradient across the FFR, noting substantial dose fall off at the lateral aspect of the respirator. Additional quantitative evaluation of dose via UVGI meter at 5 different locations on the FFR is demonstrated in Table 2.