Conventional Radiology Evaluation of Neonatal Intravascular Devices (NIVDs): A Case Series

Abstract

Our radiology department conducted an assessment of 300 neonatal radiographs in the neonatal intensive care unit over almost two years. The purpose was to evaluate the correct positioning of intravascular venous catheters. Our case series revealed that out of a total of 95 cases with misplaced devices, 59 were umbilical venous catheters and 36 were peripherally inserted central catheters. However, all of the central venous catheters were found to be properly positioned. Misplacements of neonatal intravascular devices were found to occur more frequently than expected. The scientific literature contains several articles highlighting the potential complications associated with misplaced devices. Our goal is to highlight the potential misplacements and associated complications that radiologists may encounter while reviewing conventional radiology imaging. Based on our experience, which primarily involved placing UVCs and PICCs, we discovered that conventional radiology is the most effective method for assessing proper device placement with the lowest possible radiation exposure. Given the high number of neonatal vascular device placement procedures, it is essential for radiologists to maintain a high level of vigilance and stay updated on the latest developments in this field.

Keywords: conventional radiology; emergency radiology; neonatal intensive care unit; pediatric emergency radiology; pediatric radiology.

Figure 1

The peripherally inserted central catheter (PICC) of the male infant has been correctly placed, with its tip located at the level of the sixth dorsal vertebra. Nasogastric tube is present and well positioned too.

Figure 2

The umbilical venous catheter (UVC) has been correctly positioned in a male newborn, with its distal tip projecting at the level of the 9th dorsal vertebra. The accompanying image also shows that both the peripherally inserted central catheter (PICC) and nasogastric (NG) tube have been appropriately placed.

Figure 3

The inferior vena cava cannulation in a female newborn has resulted in a satisfactory position of the distal apex of the UVC at the T9 level.

Figure 4

The distal apex of the UVC in a male newborn, born an hour prior, has been inaccurately positioned within the umbilical vein at the level of L3.

Figure 5

The distal apex of CVC in a male, 8 years old, has been appropriately positioned in the right atrium at the level of the posterior arch of the fourth rib and between the 5th and the 6th thoracic vertebra.

Figure 6

The placement of UVC is inaccurate in a male infant born five hours prior, with the distal apex of CVO positioned at the level of L4 in the inferior mesenteric vein.

Figure 7

The distal end of the PICC in a male newborn has been inaccurately placed within the internal jugular vein at the level of the first rib’s posterior arch.