M-mode and two-dimensional echocardiography in the routine follow-up of central venous catheters in children receiving total parenteral nutrition.

A retrospective study in 38 children (1 day to 7 years) on total parenteral nutrition (TPN) (1 month-24 months) with a central venous catheter (CVC) evaluated the contribution of two-dimensional echocardiography (2D) and M-mode in the follow-up of CVC location and early diagnosis of related complications. Fifty examinations were performed routinely in 21 patients (group I) and 40 in 17 patients for sepsis of the CVC or clinical suspicion of thrombosis (group II). The tip of the CVC was located in the upper right atrium in 17 cases (45%), superior vena cava in 14 cases (37%), jugular or subclavian vein in 5 cases (13%), and was not visualized in 2 cases (15%). In group I, 2D was normal in 19 cases, and catheter thrombosis suspected in 2 was not confirmed by digital angiography (DA). In group II, 2D was normal in 11 cases. In 6 patients, subxiphoid and suprasternal planes identified superior vena cava thrombus in the right atrium (DA confirmed the diagnosis in 2). In 2 pulmonary embolism occurred (1 case died); the remaining patients were successfully treated by medical therapy and removal of the catheter. Echocardiography is a useful noninvasive technique to control CVC tip location and follow-up. In this study, the sensitivity of cardiac thrombus detection by echocardiography was 100% and the specificity 93%; this method appeared, therefore, appropriate for early detection of cardiac thrombosis in pediatric patients on TPN.