Unique Cases of Intracavitary-Electrocardiogram Success in the Pediatric Intensive Care Unit: Jump Aboard, Innovators!

2020 ◽  
Vol 25 (2) ◽  
pp. 44-47
Author(s):  
Mark D. Weber ◽  
Stephanie Watts ◽  
Rachael Crowe ◽  
Adam S. Himebauch ◽  
Thomas Conlon
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Chest Radiograph ◽  
Pediatric Intensive Care ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Tip Position ◽  
Routine Chest

Highlights Abstract Proper peripherally inserted central catheter (PICC) placement has traditionally been confirmed by the use of a chest radiograph. With the innovation of the intracavitary electrocardiogram (IC-ECG), the use of a routine chest radiograph is not indicated. However, in many pediatric centers a chest radiograph is still required by policy. This article describes 4 cases in which PICC lines were properly placed using IC-ECG and the routine chest radiograph was unable to locate the PICC tip position.

Routine Chest Radiographs in Pediatric Intensive Care: A Prospective Study

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 465-470
Author(s):  
Gabriel J. Hauser ◽  
Murray M. Pollack ◽  
Carlos J. Sivit ◽  
George A. Taylor ◽  
Dorothy I. Bulas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Clinical Impact ◽  
Chest Radiographs ◽  
Clinical Value ◽  
Level Of Training ◽  
Routine Chest

The clinical value of routine chest radiographs was prospectively evaluated in a pediatric intensive care unit. Physicians were asked to predict findings of clinical impact in 353 routine morning chest radiographs performed in 101 patients after examining the patients. In 81 instances (23%), the clinical impact of the chest radiographs was incorrectly predicted and significant alterations in management would have potentially been missed had the chest radiographs not been available. These 81 chest radiographs included 72 unpredicted radiographic changes of clinical significance, and nine chest radiographs in which a significant radiographic change was incorrectly predicted. Thirty five (43.2%) of these 81 chest radiographs had unpredicted pulmonary findings and 46 (56.8%) showed unpredicted appliance malpositions. Incorrect predictions were significantly associated with radiographs from patients who were younger, intubated, mechanically ventilated, and had indwelling central venous catheters. Level of training of the predicting physicians did not affect prediction accuracy. In analysis of 43 routine postintubation chest radiographs and 39 routine postcentral venous catheter placement chest radiographs, appliance malpositions were disclosed in 34.9% and 43.6%, respectively. Routine daily and postappliance placement chest radiographs have significant clinical value in the pediatric intensive care unit.

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