ECG and POC Ultrasound guided central line insertion in neonates

• Research type

  Research Study

• Full title

  Accuracy of ECG-guided tip placement and point of care ultrasound scan (POC-US) during central line insertion in neonates – a feasibility study CLIN study

• IRAS ID

  278082

• Contact name

  Jayanta Banerjee

• Contact email

  jayanta.banerjee@nhs.net

• Sponsor organisation

  Imperial College London

• Duration of Study in the UK

  1 years, 0 months, 0 days

• Research summary

  Both premature and term neonates in neonatal intensive care commonly require central venous access to deliver intravenous nutrition and/or certain medication, whilst reducing the need for repeated peripheral cannulation. Central venous access is gained either through the umbilical cord (umbilical venous catheter, UVC) or through peripheral veins (long lines, LL).

  The end position of these lines is crucial to ensure safe care – in particular, incorrect positioning when the tip of the catheter lying in the liver or in the heart can cause severe complications.
  Current practice is to perform a plain radiograph (X-ray) of the abdomen/chest to visualise the tip of these catheters after insertion. However, this method may not be the most accurate, as it is a two-dimensional image, and furthermore involves a small dose of radiation to babies.

  In this study, we plan on observing the safety and feasibility of using two novel methods for confirming the catheter tip position: using intracavitary ECG and ultrasound, both of which are safely used in adults/children, but not yet been use routinely in the neonatal population. These novel methods may enable more accurate positioning of the catheter tip in the large veins near the heart. The study will compare the accuracy of these two methods both with each other, and with the traditional radiograph in 40 neonates (20 UVC, 20 LL), as well as observing for potential complications and following up the catheter tip position the following days. During the study, routine protocol for insertion of the LL/UVC will still be followed, and all patients will have a radiograph performed once the catheter is secured after both ECG and ultrasound have been used to optimise the catheter position. The procedure will be performed by the specialist research team, who are trained in using these new methods.

• REC name

  HSC REC B

• REC reference

  21/NI/0009

• Date of REC Opinion

  27 Jan 2021

• REC opinion

  Further Information Favourable Opinion