Introduction Improper placement of neonatal peripherally inserted central catheter (PICC) lines may cause tamponade or death. X-rays taken after PICC insertion do not always allow adequate visualization of the catheter tip. Contrast infused through the catheter prior to radiography may enhance visualization. The objective of this study was to perform a prospective, blinded trial to compare the adequacy of radiography alone to radiography following contrast administration for visualizing PICC tip position.
Methods Following PICC placement in 19 NICU patients (median BW 2.5 kg) an initial x-ray was taken. Then 0.4 ml of contrast (Omnipaque) was flushed into the PICC and a second x-ray was taken. The 38 films were converted to JPEG images at optimal resolution. Two neonatologists and one radiologist, blinded to the presence or absence of contrast, read the films and answered standardized questions regarding PICC tip visualization and location.
Results Contrast infusion did not result in subjective improvement of catheter tip visualization with poor visualization occurring in 50.9% of the non-contrast films versus 43.9% of the contrast films (p = .453). This effect may have been due to contrast pooling from the catheter tip (in 23% of the x-rays). Tip location was concordant between the paired sets of films 83.9% of the time. Tip location on the contrast films was deemed to be more central (10.7%) and more distal (5.4%, p = .297). In one infant, the 3 reviewers agreed that the contrast film showed the PICC within the heart, but on the non-contrast film, the PICC was judged to be in a more distal vein (2/3).
Conclusions Routine use of contrast with radiography could help improve PICC tip visualization. In 1 of 19 subjects (5.3%), the use of contrast images may have prevented a potential life-threatening complication.