Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop
{"title":"经胸超声心动图在儿童中心静脉导管尖端定位中的应用：经食管超声心动图作为参考方法的观察性研究。","authors":"Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop","doi":"10.1111/pan.15059","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.</p><p><strong>Aims: </strong>We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.</p><p><strong>Methods: </strong>This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.</p><p><strong>Results: </strong>150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).</p><p><strong>Conclusion: </strong>TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.</p><p><strong>Trial registration: </strong>German Clinical Trial Register: DRKS00028271.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"310-315"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883508/pdf/","citationCount":"0","resultStr":"{\"title\":\"Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.\",\"authors\":\"Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop\",\"doi\":\"10.1111/pan.15059\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.</p><p><strong>Aims: </strong>We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.</p><p><strong>Methods: </strong>This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.</p><p><strong>Results: </strong>150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).</p><p><strong>Conclusion: </strong>TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. 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Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.
Background: Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.
Aims: We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.
Methods: This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.
Results: 150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).
Conclusion: TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.
Trial registration: German Clinical Trial Register: DRKS00028271.
期刊介绍：
Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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