Ultrasonographic detection of very thin percutaneous central venous catheter in neonates

To assess the ability of ultrasonography to detect the tip of a very thin ( 0.4 mm outer diameter) percutaneous central venous catheter (PCVC) in neona tes, the PCVC tip location was assessed by ultrasonography (US) and compare d to the location estimated by standard radiography for 57 PCVCs in 44 neon ates. Of 57 occasions, the examiner could not find the PCVC tip in three ca ses (5%). In the remaining 54 instances, in 87% of cases, the PCVC tip posi tion was consistent with the location implied by skeletal landmarks on stan dard radiographs. On 24 occasions we also assessed catheter tip dislodgemen t according to flexion and extension of the infant's arm. US could detect 7 8% of cases of catheter tip dislodgement. The PCVC tip was sometimes visual ized as a dot and parallel lines as well as mere parallel lines. In a large population of cases, US is a reliable method for detection of a thin PCVC tip. US provides precise information about the PCVC tip position in relatio n to vascular structure and contributes to safer positioning of the PCVC th an traditional radiography alone.