Optimal radiologic position of an umbilical venous catheter tip as determined by echocardiography in very low birth weight newborns

Karber, B.C.F.; Nielsen, James C.; Balsam, Dvorah; Messina, Catherine R.; Davidson, Diane W.

doi:10.3233/npm-1642

Cited by 27 publications

(35 citation statements)

References 18 publications

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“…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%

“…In only 1/40 infants we could not visualize the UVC tip by US. To improve the detection of migration and malposition of UVCs, US is a valuable and feasible tool, as it mostly takes only a few minutes and avoids additional exposure to radiation [17, 24]. Our study showed that inadvertent migration occurs frequently between the placement of the UVC and Day 3.…”

Section: Discussionmentioning

confidence: 81%

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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: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 81%

Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

et al. 2019

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“…We described 12 cases where the UVC tip was in the heart despite reassuring X‐ray findings, 3 within the LA (2%) and 13 within the RA (9%), demonstrating that determination of UVC tip position by vertebral level on X‐ray alone is problematic. This poor correlation between X‐ray vertebral position and CPU position has previously been shown by others . In a study of 65 extremely low birthweight neonates, Franta et al .…”

Section: Discussionmentioning

confidence: 70%

“…demonstrated LA and RA malposition at a rate of 45% (24) and 28% (15), respectively. Karber et al . noted a rate of 41% (21) of UVCs in the LA in a study of 51 extremely low birthweight neonates despite adequate position on X‐ray.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first reports of the use of ultrasound in confirming UVC placement, 9,10 studies have suggested that ultrasound confirmation of the safe placement of UVCs should be considered standard. [2][3][4][5][11][12][13][14][15][16][17] Ultrasound enables precise determination of the catheter tip in relation to the portal venous system, IVC and heart, thereby minimising complications related to malposition within the liver or heart, as well as avoiding or minimising exposure to X-ray radiation. Our results demonstrate that CPU for line localisation is clinically useful, with CPU informing further management of the line in 41% and identifying unsafe placement despite adequate X-ray position in 14% (15 cases).…”

Section: Discussionmentioning

confidence: 99%

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Use of clinician‐performed ultrasound in the assessment of safe umbilical venous catheter tip placement

Seigel

Evans

Lutz

2019

J Paediatrics Child Health

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Aim Safe tip placement of umbilical venous catheters (UVCs) in sick neonates is critical in minimising risk. We aimed to demonstrate the utility of clinician‐performed ultrasound (CPU) in identifying UVCs that are placed within small intrahepatic portal vessels or within the heart despite the appearance of being well placed on X‐ray. Methods This was a retrospective observational study of preterm and term neonates who had a UVC placed and the position assessed by X‐ray and/or CPU according to the Royal Prince Alfred Hospital level 3 neonatal intensive care unit (NICU) guideline. Cases were identified by exporting the records of all admissions between 1 April 2015 and 30 June 2016 from the NICU's data collection database. Paper‐based medical records, NICU's data collection database records and the ultrasound reporting system were reviewed to determine X‐ray and CPU findings. Results A total of 157 neonates had 169 UVCs placed. CPU was performed in 77% (111). In 15 cases (14%), UVC placement on X‐ray appeared appropriate based on estimated vertebral level; however, CPU demonstrated the line to be in an unsafe position (small intrahepatic portal vessel (3); right atrium (9); left atrium (3)). Conclusions Assessment of safe UVC placement by estimations according to vertebral level on X‐ray alone is inadequate. CPU offers confident localisation of the UVC tip and enables corrective manipulation of intracardiac or intrahepatic UVCs in real time. We recommend CPU as an adjunct to X‐ray to ensure safe UVC placement.

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