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Does ultrasound guidance for peripherally inserted central catheter (PICC) insertion reduce the incidence of tip malposition? – a randomized trial

Journal of Perinatology volume 39, pages 95–101 (2019)Cite this article

Subjects

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.

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Author contributions

TO: Writing the protocol, collecting data and having written the first draft of the manuscript. RA: Conceptualized the study, helped in writing protocol, final analysis and contributed to the final manuscript. AKG: Helped in interpretation of outcome measurement and contributed to final manuscript. SV: Helped in sample size calculation and statistical analysis and contributed to the final manuscript. AT: Helped in writing protocol, forming standard of practice for implementation of study and writing final manuscript. JSM: Helped in writing initial protocol and final analysis of the data and contributed to the final manuscript. AKD and VKP gave critical inputs in designing and execution of the study and critically reviewed the manuscript.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Tejopratap Oleti, M. Jeeva Sankar, Anu Thukral, Ramesh Agarwal, Ashok K. Deorari & Vinod K. Paul

  2. Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    V. Sreenivas

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Arun Kumar Gupta

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  1. Tejopratap Oleti
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Correspondence to Anu Thukral.

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Oleti, T., Jeeva Sankar, M., Thukral, A. et al. Does ultrasound guidance for peripherally inserted central catheter (PICC) insertion reduce the incidence of tip malposition? – a randomized trial. J Perinatol 39, 95–101 (2019). https://doi.org/10.1038/s41372-018-0249-x

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