Ultrasound Versus Fluoroscopy for Catheter Tip Confirmation in Long-Term Vascular Access: A Prospective Observational Study

TL;DR

This study shows that ultrasound can accurately confirm the placement of long-term vascular catheters in children, offering a safer and cheaper alternative to fluoroscopy.

Contribution

The study introduces ultrasound as a reliable alternative to fluoroscopy for catheter tip confirmation in pediatric patients.

Findings

Ultrasound and fluoroscopy showed 92.5% agreement in catheter tip placement.

Ultrasound was 100% accurate for catheter tips in the right ventricle.

The method is quick, cost-effective, and avoids radiation exposure.

Abstract

Study design and objective: A prospective observational study aimed to study the use of ultrasonographic location of the catheter tip as an alternative to on-table fluoroscopy in determining the correct placement of long-term vascular access devices (VADs) in children.

Methods: The study was conducted in a large, tertiary care, teaching hospital in South India. A total of 30 consecutive paediatric haemato-oncology patients were planned for surgical insertion of long-term VADs (HickmanTM catheter (Bard Access Systems, Salt Lake City, UT, USA) or Port-a-Cath® (Smiths Medical, St. Paul, MN, USA)), recruited over a period of three months. The primary outcome of the study was to see if the ultrasonographic location of the catheter tip was in agreement with on-table fluoroscopy findings.

Procedure: After surgical insertion of the long-term VAD, an intra-operative trans-thoracic ultrasonography of the heart was done prior to fluoroscopy. A four-chamber view of the heart was obtained using either the sub-xiphoid or apical view. With the heart chambers in view, 2 mL of saline was injected rapidly into the external port, and the corresponding turbulence was visualized in real-time on transthoracic echocardiography (TTE). Depending on the site of appearance of the turbulence, the catheter tip location was inferred (right atrium (RA), above the RA, or in the right ventricle (RV)). The location of the catheter tip was then verified using fluoroscopy. ​​​​Kappa statistics were calculated to obtain the degree of agreement between ultrasound and fluoroscopy.

Results: We found a 92.5% overall agreement between ultrasound and fluoroscopy, which was significant (p-value <0.01). The degree of agreement was 100% for the RV positions, while it was 95.5% for the RA position, and 83.3% for the above RA.

Conclusion: Ultrasonographic confirmation of the vascular catheter tip position is a quick, easy-to-perform, cost-effective, and safe alternative to fluoroscopy.