Positioning newborns on their back or right side for umbilical venous catheter insertion

Kieran, Emily A; Laffan, Eoghan; O’Donnell, Colm P.

doi:10.1111/apa.13525

Cited by 13 publications

(7 citation statements)

References 16 publications

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“…Pennaforte et al ( 35 ) have recommended the manual mobilization of the liver during UVC insertion. Other authors ( 36 ) have suggested placing the infant on the right side during UVC insertion, since this position might reduce the risk of tip progression into the portal venous circulation. Another maneuver suggested is the compression of the upper abdomen near the portal sinus of the liver, to align the umbilical vein and DV, under ultrasound guidance ( 37 ).…”

Section: Insertion Of the Uvc Including New Technologiesmentioning

confidence: 99%

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

et al. 2022

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The umbilical venous catheter (UVC) is one of the most commonly used central lines in neonates. It can be easily inserted soon after birth providing stable intravenous access in infants requiring advanced resuscitation in the delivery room or needing medications, fluids, and parenteral nutrition during the 1st days of life. Resident training is crucial for UVC placement. The use of simulators allows trainees to gain practical experience and confidence in performing the procedure without risks for patients. UVCs are easy to insert, however when the procedure is performed without the use of ultrasound, there is a quite high risk, up to 40%, of non-central position. Ultrasound-guided UVC tip location is a simple and learnable technique and therefore should be widespread among all physicians. The feasibility of targeted training on the use of point-of-care ultrasound (POCUS) for UVC placement in the neonatal intensive care unit (NICU) among neonatal medical staff has been demonstrated. Conversely, UVC-related complications are very common and can sometimes be life-threatening. Despite UVCs being used by neonatologists for over 60 years, there are still no standard guidelines for assessment or monitoring of tip location, securement, management, or dwell time. This review article is an overview of the current knowledge and evidence available in the literature about UVCs. Our aim is to provide precise and updated recommendations on the use of this central line.

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Section: Insertion Of the Uvc Including New Technologiesmentioning

confidence: 99%

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

et al. 2022

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“…4e6 Malposition is the most common UVC-related complication, with the malposition rate on radiography reported to range from 19.4% to 48%. 11,12 Our findings indicate that an improper UV catheter position is the most important risk factor for HE; the catheter was positioned below the diaphragm in 25 (75.8%) cases and below the T9 level in 26 (78.8%) cases. A large series study including 1081 neonates observed that a low UV catheter position increased the potential for HE injury, 9 (0.8%) developed severe hepatic injury and all the patients had the UVC malpositioned within the liver circulation.…”

Section: Discussionmentioning

confidence: 75%

Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience

Chen

Chao

Chiang

et al. 2020

Pediatrics & Neonatology

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Background: Care of newborns in the neonatal intensive care unit generally involves umbilical venous catheterization (UVC) for central vein access to enable medical needs. The study aimed to evaluate the sonographic appearance, risk factors, and outcomes of UVCrelated hepatic extravasation (HE) in neonates. Methods: A 5-year retrospective study where 33 neonates were enrolled with a diagnosis age ranging from 2 to 25 days. 78.8% of the subjects had UVC malpositioning shown on initial radiography. All neonates sonographically diagnosed with HE, and follow-up ultrasound (US) was performed. Results: The main findings of HE on US were hyperechoic or heterogeneous lesions of a lobulated (51.7%) or wedge shape (48.3%), located mainly in the left lobe (72.7%). The mean time to resolution of HE was 2.25 months. Seven (21.2%) patients showed hepatic vascular thrombosis at follow-up. Two (6%) patients had abnormal liver function, which subsequently normalized. Conclusion: Malposition of the UV catheter was the predisposing factor for UVC-related HE in neonates. US facilitates detection of UVC malpositioning and diagnosis of HE, as well as delayed complications. A shorter duration of UVC placement is associated with favorable outcomes of UVC-related HE in neonates.

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“…Therefore, the procedure is often undertaken ‘out of hours’ by doctors with variable experience. Measures to improve the rate of successful insertion such as positioning infants on their side and applying topical nitroglycerin ointment have been trialled without significant improvement .…”

Section: Resultsmentioning

confidence: 99%

Magnifying lenses to aid umbilical catheter insertion

et al. 2018

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Positioning newborns on their back or right side for umbilical venous catheter insertion

Abstract: Positioning newborn infants on their right side did not result in more correctly placed umbilical venous catheters. The procedure was well tolerated and reduced the rate of tip insertion into the portal venous circulation.

Cited by 13 publications

References 16 publications

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience

Magnifying lenses to aid umbilical catheter insertion

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