NeoNav ECHO Study: Determine what electrocardiogram (ECG) waveforms are associated with central venous access lines placed in babies and checked by ultrasound

Neonatal patients requiring central venous catheters will be recruited. The procedure itself will be performed as per usual clinical practice with only one minor adjustment, i.e. the placement of a small adapter between syringe and catheter hub that allows for detection of intravascular ECG (IV-ECG) signals through the saline solution. With informed consent, the IV-ECG will be recorded for analysis to determine characteristic IV-ECG features as they related to catheter tip position as determined by imaging. An ultrasound (echocardiogram, ECHO) will be performed immediately after insertion to determine the location of the catheter tip within the participants vascular system. Repeat recordings and ultrasound tip determination will be repeated daily until the catheter is removed as per decision of the clinical team. Both the IV-ECG recoding and ECHO will only take a few minutes (<10 min) each. While the clinician performing the procedure will place the adapter, the IV-ECG recording will be performed by the research team and a neonatologist certified in ultrasonography (who is part of the research team) will perform the ultrasound. While the focus of this observational trial is to define how intravascular ECG features correlate with a specific catheter tip positions on imaging, we like to note that a new ECG device (only available for use in this trial and used under TGA Clinical Trials Notification) is used to record intravascular and surface ECGs. As the procedure is being performed as per usual practice and without changes or interventions, this new device is only used in an observational manner. Daily recordings will be performed and the removal of the catheter will be determined by the clinical team, thus the number of recordings per participant will vary according to indwelling time of the catheter.