36 Contrast Enhanced Radiography for Peripherally Inserted Central Venous Catheter Tip localization- Is it really needed for all infants?
Notice bibliographique
Résumé
Abstract Background Contrast enhanced radiography (CER) is considered one of the best available methods for localizing the tip of a peripherally inserted central venous catheters (PICC) in neonates, which was the standard practice at our NICU. It was observed that multiple catheter readjustments and radio-graphs were required due to contrast jet appearing radio-graphically as a distal extension of the catheter creating a false impression of deep location of the PICC tip. This raised the question of whether we need to use contrast routinely for all infants or can we selectively use contrast when needed. Objectives The intention of this quality improvement project was to adopt the use of plain radiography (PR) as the first modality for PICC tip localization and use CER only if localization was unsuccessful in the first instance. The objective was to examine the effect of this change of clinical practice on the: a) number of radio-graphs taken for PICC insertions b) the frequency of intravenous contrast use in PICC insertion. Design/Methods This was a QI initiative conducted over a 7 month period. After educating all care providers who insert PICC, we changed our practice to use plain radiography as first modality for PICC tip visualization starting June 1, 2019. CER was only used if catheter tip was not visualized on plain radiography. We collected the information on infants who had PICC inserted in the NICU before and after the implementation of the initiative for a given period. Outcome measures were a) proportion of infants with PICC tip visualized on first plain radiography (b) proportion of infants who received CER (c) Number of X-rays per line insertion. We compared the data regarding the above outcomes between the two time periods. Results Of the 113 PICC inserted, 39 PICCs were inserted during routine CER period, and 74 PICCs were inserted during PR period. The mean gestational age (26 ± 2.8 vs 27± 3.5), birth weight (878 ± 406g vs 1024g ± 559g, site of insertion - upper limb PICC (74% vs 69%) were comparable between the two groups. Catheter was visualized on first plain radiography in 56/74 (75%) in the PR period. Overall, the CER was performed in 30/74 (40%), of which 18 were for non-visualization of tip on first plain radio-graph and 11 for non-visualization after subsequent manipulation. There was no difference in the median (IQR) number of radio-graphs between CER period and PR period [2 (2-3) vs 2 (1-3), p =NS] with similar proportion of infants requiring 2 or less X-rays (71% vs 67%). Conclusion The use of plain radiography as the initial imaging modality is a safe alternative, without increasing radiation exposure and it minimizes the use of intravenous contrast in neonates undergoing PICC insertions. In spite of being superior for tip visualization, CER does not reduce the number of X-rays taken for the same purpose.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,045 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».