Comparing the Accuracy of Echocardiography and Radiography for Evaluation of Tip Position of Peripherally Inserted Central Catheters: Experienced in an NICU in Iran

Background: Echocardiography (ECHO) is a non-radiation real-time technique for evaluating Peripherally Inserted Central Catheter (PICC) tips that could overcome the limitations of plain radiographs, including the static and single image and exposing neonates to radiation. This study compared the accuracy of ECHO and radiography for PICC tip positioning in neonates. Methods: This cross-sectional pilot study was conducted in the neonatal intensive care unit (NICU) of the Children's Medical Center in Tehran, Iran. Ultrasonography was used to visualize the end of the catheter in the vessels. After insertion of the catheter, a chest x-ray along with the ECHO was performed by a pediatric cardiologist blinded to the preliminary radiographic reports, and the results were compared and interpreted. Results: Forty infants with mean gestational ages of 35.4 +/- 3.3 weeks were enrolled in this study which was conducted during 12 months, from 2019 to 2020. The radiography results confirmed the correct PICC location in 29 infants (72.5%), which was simultaneously confirmed by ECHO in 28 infants (70.0%). The ECHO results indicated inappropriate placement in 12 infants (30%), and radiographs indicated correct placement in 11 infants (27.5%). This confirmed the higher accuracy of ECHO compared to radiography. ECHO had a sensitivity of 100%, specificity of 96.55%, PPV of 91.67%, NPV of 100%, and diagnostic accuracy of 97.5%. Both methods were appropriately correlated regardless of the demographics characteristics, sex, birth weight, gestational age, and catheter insertion site. Conclusion: The findings confirmed that ECHO was more accurate than radiography for visualizing PICCs tip placement. ECHO does not require radiation exposure, has fewer complications, and is faster than radiography; thus, it should be considered as an alternative to standard radiography for line tip confirmation.