Ultrasound-guided umbilical catheter insertion in neonates

Abstract

Objective: Umbilical catheter placement is a routine neonatal emergency procedure that has large variability in technical methods. Commonly used methods are unable to accurately estimate insertion lengths, and X-rays cannot always identify malpositioned catheters. In clinical practice, the placement of umbilical lines takes time away from nursing during a critical transition period. Ultrasound is a safe and commonly used tool in the nursery for clinical management of sick neonates and has been shown to readily identify central catheter tip position. In this study, we sought to determine a more time-efficient and accurate means of umbilical catheter placement using bedside ultrasound.Study Design: This is a prospective, randomized, pilot trial of infants of any age or weight admitted to the neonatal intensive care unit who required umbilical catheter placement. Infants were excluded if they had congenital heart disease, abdominal wall defects or had a single umbilical artery. Catheters were placed using either the conventional method, with blinded evaluation of the catheters using ultrasound, or with ultrasound guidance, with input pertaining to catheter tip location. The number of X-rays required to confirm proper positioning, completion time points throughout the procedure and manipulations of the lines were recorded for both groups.Result: Ultrasound use decreased the time of line placement with an average saving of 64 min, as well as decreased the number of manipulations required and X-rays taken to place the catheters. The average X-ray time from request to viewing per X-ray was 40 min for all subjects.Conclusion: Ultrasound-guided umbilical catheter placement is a faster method to place catheters requiring fewer manipulations and X-rays when compared with conventional catheter placement.

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

“…Fleming and Kim28 reported movement of umbilical catheter tip by 0.54 cm towards the heart when radiographs are taken with hips and knees flexed as compared with fully extended legs. This is unlikely to influence in our series as all infants were in semiflexed position at all time points as well as for the radiograph, either spontaneously or gently held by their nurse.…”

Ultrasound to diagnose spontaneous intestinal perforation in infants weighing ⩽1000 g at birth

“…Ultrasound has been used for bedside confirmation of umbilical line placements and has been found to save patients from extra radiation, save time, decrease the amount of manipulations required to place a line and optimize catheter placement. [9][10][11] Other investigators have used ultrasound for the diagnosis of NEC. [15][16][17][18] Like SIP, the standard of care includes abdominal radiographs for diagnosing NEC; however, abdominal ultrasound appears to have several distinct advantages over X-rays.…”

“…Ultrasound technology has been increasingly utilized in the NICU for bedside confirmation of umbilical line placements, [9][10][11] functional echocardiography [12][13][14] and to aid in the diagnosis of NEC. [15][16][17][18] However, until now there has been limited information available on its sensitivity and specificity on diagnosing SIP.…”

Training of Ultrasound in Neonatology: Global or Local?

“…[34][35][36] Ultrasound-guided umbilical catheter placement is a faster method to place catheters requiring fewer manipulations and X-rays when compared with conventional catheter placement, although it is still not widely used due to the lack of proper training. 37 Real-time ultrasound could be used to place a peripherally inserted central catheter (PICC). This method of placement of PICC reduces catheter insertion duration, and is associated with fewer manipulations and radiographs when compared with conventional placement.…”