Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study

Franta, Jan; Harabor, Andrei; Soraisham, Amuchou

doi:10.1136/archdischild-2016-311202

Cited by 68 publications

(84 citation statements)

References 33 publications

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“…In our study, we assessed a UVC with the catheter tip still in the correct position as migrated as well if it migrated to another anatomical structure or over a distance of at least 0.5 cm. Only including migration of UVCs that result in malpositions, our migration rate would be 42%, thus comparable to the migration rate in the study of Franta et al [18]. …”

Section: Discussionsupporting

confidence: 67%

“…There is limited data demonstrating that US is superior for determining the position of the UVC when compared to CXR [10, 12, 13, 18, 24, 25]. Although other authors report poor correlation between the thoracic level by CXR and catheter location by US [10, 12, 13, 18, 24, 25], we found agreement between CXR and US in 23/30 imaging pairs. However, comparison of US and CXR in determining the UVC position was not the primary goal of this study, and conclusions about the accuracy of both modalities cannot be drawn.…”

Section: Discussionmentioning

confidence: 42%

“…Case reports described UVC-related complications such as pericardial effusion, left atrial thrombosis, and intrahepatic hematoma in infants with a migrated UVC at the time of detection of the complication [15, 16]. Gupta et al [11] reported that 36% of the UVCs migrated into the cardiothymic silhouette on CXRs within 1 h after insertion, and 23% after 24 h. Franta et al [18] very recently performed a prospective study using serial US. During the inclusion period of our study, they reported a migration incidence of 50% and, despite adjustments of the UVC position if needed, malposition re-occurred in 23–62% on the different scans.…”

Section: Discussionmentioning

confidence: 99%

“…Others explain inward migration of the UVC by a downward movement of the IVC-RA junction caused by lung expansion and diaphragmatic descent, resulting in an upward movement of the catheter tip [16]. Other risk factors for migration have been suggested, such as birth weight, weight and postnatal age at insertion, and changes in the ventilation mode [11, 18]. Although we documented ventilation mode and weight loss, our study group was too small to investigate the relation of these factors with UVC migration.…”

Section: Discussionmentioning

confidence: 99%

“…Abdominal girth variation is suggested as a possible cause of UVC migration [15, 18]. Some authors speculate that abdominal distension will lead to outward migration [18].…”

Section: Discussionmentioning

confidence: 99%

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Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

et al. 2019

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Background: Migration of umbilical venous catheters (UVCs) has been described anecdotally. Objectives: The aim of this paper was to investigate migration of UVCs using ultrasonography (US). Methods: In a prospective observational study, the position of UVCs was determined using serial US within 24 h, at midweek, and at the end of the week after umbilical catheterization. Migration was recorded in distance and direction. Malposition was defined as a position of the UVC in the heart (right atrium or more distal along the UVC-route), umbilicoportal confluence, or in the umbilical vein. UVC position determined by US was compared with chest X-rays (CXRs) when these were performed for standard care within the same period of 1 h. Results: Migration of UVCs was detected with US in 25/40 infants (63%) in 32 occasions, leading to malposition in 17/25 (68%) infants. UVCs migrated inwards in 18/32 (56%), leading to a position within the heart in 17/18 occasions. Most migrations occurred before Day 3 (21/32 [66%]). When a CXR was taken at the same time as US was performed (30 occasions), the assessment of the catheter-tip position differed in 23% of the occasions. When malposition was detected by US, this was detected on routinely performed CXRs in 11% of the occasions. Conclusions: UVCs often migrate following insertion, often leading to malposition. Awareness for this is needed, and US is a feasible alternative for detecting malposition compared to CXRs and avoids additional radiation. Re-evaluation of the position of UVCs at least once, but within 24 h after placement, is recommended.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Abdominal girth variation is suggested as a possible cause of UVC migration [15, 18]. Some authors speculate that abdominal distension will lead to outward migration [18].…”

Section: Discussionmentioning

confidence: 99%

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Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

et al. 2019

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Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns

et al. 2017

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Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r = 0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r = 0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r = 0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r = 0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r = 0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151° [133-159]; r = 0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128° [123-144]; r = 0.0001) than that of the segmental portal vein (115° [105-119]; r = 0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. © 2017 Wiley Periodicals, Inc.

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Ultrasound‐Guided Umbilical Venous Catheter Insertion With Alignment of the Umbilical Vein and Ductus Venosus

Kishigami

Shimokaze

Enomoto

et al. 2019

J of Ultrasound Medicine

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Previous studies have highlighted the importance of confirming the position of an umbilical venous catheter (UVC) tip by an ultrasound (US) examination. However, methods for preventing insertion into the portal circulation under US guidance have not yet been established. We report 15 cases in which a UVC was successfully passed through the ductus venosus by compressing the upper abdomen near the portal sinus of the liver to align the umbilical vein and ductus venosus under US guidance. The UVC was inserted into the correct position in 14 of the 15 neonates (93%) without complications.

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Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study

Abstract: UVC tip localisation by standard radiography is very imprecise, and catheter tip migration occurs in a significant proportion of infants during first weeks of age. We suggest ultrasound as the best modality to assist localisation and follow-up of UVC tip in preterm infants.

Cited by 68 publications

References 33 publications

Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns

Ultrasound‐Guided Umbilical Venous Catheter Insertion With Alignment of the Umbilical Vein and Ductus Venosus

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