Anatomical landmarks on radiography for peripheral central catheter in newborns: integrative review

Secco, Izabela Linha; Danski, Mitzy Tannia Reichembach; Lomba, Maria de Lurdes; Pereira, Higor Pacheco; Arrué, Andrea Moreira

doi:10.37689/acta-ape/2023AR006622

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Acta Paulista de Enfermagem

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Review Article • Acta Paul Enferm 36 • 2023 • https://doi.org/10.37689/acta-ape/2023AR006622 copy

Anatomical landmarks on radiography for peripheral central catheter in newborns: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To summarize the scientific evidence on anatomical landmarks on radiography used to evaluate the distal tip of the peripherally inserted central catheter in newborns.

Methods

This is an integrative literature review performed between 2017 and 2021 in Web of Science, National Library of Medicine (PubMed/MEDLINE) and Scopus databases.

Results

Thirteen out of 263 documents found in the databases met the eligibility criteria and were selected for analysis. Of these, 12 were observational studies and one was experimental. As for the country of origin, only one study was published in Brazil, five in China, two in the United States of America; and Italy, Germany, Canada, Iran and India with one study each. The evidence found demonstrated the existence of seven anatomical landmarks used in radiography to visualize the tip of the percutaneous catheter in newborns, and the vertebral body as the predominant guiding reference.

Conclusion

For catheters inserted in the upper limbs, the anatomical landmarks closer to the cavo-atrial junction are the fifth and seventh thoracic vertebrae, or two vertebral bodies below the level of the carina. For the lower limbs, the catheter tip should be positioned between the ninth and tenth thoracic vertebrae or above the fourth lumbar vertebra.

Anatomic landmarks; Radiolgraphy, thoracic; Catheterization, peripheral; Infant, newborn

N^o	Authors, country and year of publication	Title	Anatomical landmarks on radiography	Level of evidence
1	Goldwasser B; Baia C; Kim M; Taragin BH; Angert RM. United States, 2017.(¹⁴14. Goldwasser B, Baia C, Kim M, Taragin BH, Angert RM. Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position. Pediatr Radiol. 2017;47(12):1676-81.)	Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position.	For insertion in the upper limbs: between the brachiocephalic region to the cardiac silhouette. For insertion in lower limbs: between the fourth and fifth lumbar vertebra up to the level of the diaphragm.	III
2	Zhou L; Xu H; Liang J; Xu M; Yu J. China, 2017.(¹⁵15. Zhou L, Xu H, Liang J, Xu M, Yu J. Effectiveness of intracavitary electrocardiogram guidance in peripherally inserted central catheter tip placement in neonates. J Perinat Neonatal Nurs. 2017;31(4):326-31.)	Effectiveness of intracavitary eletrocardiogram guidance in peripherally inserted central catheter tip placement in neonates.	For insertion in upper limbs: between the fifth and sixth thoracic vertebra.	III
3	Capasso A; Mastroianni R; Passariello A; Palma M; Messina F; Ansalone A; et al. Italy, 2018.(¹⁶16. Capasso A, Mastroianni R, Passariello A, Palma M, Messina F. Ansalone A, et al. The intracavitary method for positioning the tip of epicutaneous cava catheter in neonates: pilot study. J Vasc Access. 2018;19(6):542-7.)	The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: pilot study.	For insertion in upper limbs: 1 cm above the carina up to a maximum of 2 cm from the carina.	III
4	Ling Q; Chen H; Tang M; Qu Y; Tang B. China, 2019.(¹⁷17. Ling Q, Chen H, Tang M, Qu Y, Tang B. Accuracy and safety study of intracavitary electrocardiographic guidance for peripherally inserted central catheter placement in neonates. J Perinat Neonatal Nurs. 2019;33(1):89-95.)	Accuracy and safety study of intracavitary eletrocardiographic guidance for peripherally inserted central catheter placement in neonates.	For insertion into upper limbs: between the fifth and seventh thoracic vertebra.	II
5	Hammon RA; Seuss H; Hammon M; Grillhösl C; Heiss R; Zeilinger M; et al. Germany, 2019.(¹⁸18. Hammon RA, Seuss H, Hammon M, Grillhösl C, Heiss R, Zeilinger M, et al. Improved visualization of peripherally inserted central catheters on chest radiographs of neonates using fractional multiscale image processing. BMC Med Imaging. 2019;19(3):3..)	Improved visualization of peripherally inserted central catheters on chest radiographs of neonates using fractional multiscale image processing.	For insertion in upper and lower limbs: 0.5-1 cm outside the cardiac chambers in premature newborns and 1-2 cm in full term newborns.	III
6	Rangel RJM; Castro DS; Amorin MHC; Zandonade E; Christoffel MM; Primo CC. Brazil, 2019.(¹⁹19. Rangel RJ, Castro DS, Amorim MH, Zandonade E, Christoffel MM, Primo CC. Prática de inserção, manutenção e remoção de cateter central de inserção periférica em neonatos. Rev Pesq Cuid Fundam Online. 2019;11(2):278-84.)	Practice of insertion, maintenance and removal of peripheral inserted central catheter in neonates.	For insertion in upper and lower limbs: 0.5-1 cm outside the cardiac chambers.	III
7	Yang L; Bing X; Song L; Na C; Minghong D; Annuo L. China, 2019.(²⁰20. Yang L, Bing X, Song L, Na C, Minghong D, Annuo L. Intracavitary electrocardiogram guidance for placement of peripherally inserted central catheters in premature infants. Medicine (Baltimore). 2019;98(50):e18368.)	Intracavitary electrocardiogram guidance for placement of peripherally inserted central catheters in premature infants.	For insertion in upper limbs: 3 cm below the carina.	III
8	Dhillon S; Connolly B; Shearkhani O; Brown M; Hamilton R. Canada, 2020.(²¹21. Dhillon S, Connolly B, Shearkhani O, Brown M, Hamilton R. Arrhythmias in children with peripherally inserted central catheters (CCIPs). Pediatr Cardiol. 2020;41(2):407-13.)	Arrhythmias in children with peripherally inserted central catheters (PICCs).	For insertion in upper limbs: on the sixth rib from top to bottom; or two vertebral bodies below the carina.	III
9	Hirschl JR; Gadepalli SK; Derstine BA; Holcombe SA; Smith EA; Wang SC; et al. United States, 2020.(²²22. Hirschl JR, Gadepalli SK, Derstine BA, Holcombe SA, Smith EA, Wang SC, et al. CT validation of SVC-RA junction location for pediatric central line placement: is vertebral bodies below the carina accurate? Pediatr Surg Int. 2020;36(9):1055-60.)	CT validation of SVC-RA junction for pediatric central line placement: is vertebral bodies below the carina accurate?	For insertion in the upper limbs: in children aged 0-1 years and weighing up to ten kilos, consider between 10.18-10.55 mm below the carina.	III
10	Kadivar M; Mosayebi Z; Ghaemi O; Sangsari R; Saeedi M; Shariat M; et al. Iran, 2020.(²³23. Kadivar M, Mosayebi Z, Ghaemi O, Sangsari R, Saeedi M, Shariat M, et al. Ultrasound and radiography evaluation of the tips of peripherally inserted central catheters in neonates admitted to the NICU. Iran J Pediatr. 2020;30(6):e1084416.)	Ultrasound and radiography evaluation of the tips of peripherally inserted central catheters in neonates admitted to the NICU.	For insertion in the lower limbs: above the fourth or fifth lumbar vertebra, or at the iliac crest.	III
11	Patil K; Dhaded SM; Bhandankar M. India, 2020.(²⁴24. Patil K, Dhaded SM, Bhandankar M. A 1-year study on association between peripherally inserted central catheter tip position and complications in neonates. J Indian Assoc Pediatr Surg. 2020;25(5):276-9.)	A 1-year study on association between peripherally inserted central catheter tip position and complications in neonates.	For insertion in the lower limbs: between the ninth thoracic vertebra and the fifth lumbar vertebra.	III
12	Yu X; Wang X; Fan L; Cao N; Yang F; Li J; et al. China, 2020.(²⁵25. Yu X, Wang X, Fan L, Cao N, Yang F, Li J, et al. Latrogenic pleural effusion due to extravasation of parenteral nutrition via an epicutaneo cava catheter in neonates: a prospective cohort study. Front Pediatr. 2020;8:570978.)	Iatrogenic pleural effusion due to extravasation of parenteral nutrition via an epicutaneo cava catheter in neonates: a prospective cohort study.	For insertion in the upper limbs: between the fifth and seventh thoracic vertebra. In lower limbs: between the ninth and tenth thoracic vertebra.	III
13	Ren X; Li H; Liu J; Chen Y; Wang M; Qiu R. China, 2021.(²⁶26. Ren X, Li H, Liu J, Chen Y, Wang M, Qiu R. Ultrasound to localize the peripherally inserted central catheter tip position in newborn infants. Am J Perinatol. 2021;38(2):122-5.)	Ultrasound to localize the peripherally inserted central catheter tip position in newborn infants.	For insertion in upper limbs: between 0.5 to 0.8 cm from the right atrium.	III

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[1] Corresponding author: Izabela Linha Secco E-mail: izabelasecco_enf_@hotmail.com