Real time ultrasound to assess epicutaneo-caval catheters (ECCs) tip location and migration: the Padua experience in the DISLOTIP study

Background and aims: epicutaneo-caval catheters (ECCs) are widely used in Neonatal Intensive Care Units (NICUs) but are prone to potentially life-threatening complications when they’re not properly positioned. Conventional radiography is currently the standard of care in most NICUs to assess the ECC tip location, but previous evidence has questioned this practice. Ultrasound (US) has been appointed by the recent literature and international guidelines as a valuable alternative, as it is safe, effective, time-sparing, radiation-free and can be easily bedside repeated. The primary aim of our study was to demonstrate US feasibility and reliability for ECCs tip navigation and location. Materials and Methods: conducted as part of the multi-center DISLOTIP study, our prospective, observational research included 25 neonates admitted to the NICU of Padua University Hospital who required ECC placement. Subsequent tip location assessments were performed at four time points: immediately post-insertion (T0), 1-2 hours (T1), 24-48 hours (T2), and 6-8 days (T3) after ECC placement. Results: in our analysis US feasibility was high at all the examined time points (100% at T0-T2, 95.7% at T3). At T0 the ECC tip was correctly located in distal superior vena cava (SVC) or at the cavo-atrial junction (CAJ) in all cases. Tip migration rates were notably higher within the first two hours post-insertion (44% at T1), emphasizing this time point as crucial for tip reassessment to prevent complications. The incidence of migration decreased over time, with 24% at T2 and 22.7% at T3. Notably, no significant correlation emerged between invasive ventilation and tip migration or between catheter manipulation for medication renewal and central line associated blood stream infections (CLABSI) incidence. Conclusions: our results are consistent with the current literature in underlining the feasibility, effectiveness and safety of US for ECC tip monitoring in neonates, advocating for its integration into NICU protocols as a new standard of care. Further multi-center studies are needed to produce stronger and replicable results.