Umbilical vascular catheters: Localization by two-dimensional echocardio/aortography

Abstract

Umbilical vascular catheters are often necessary in the care of critically ill neonates. Position of the catheter tip is usually determined by roentgenography. Location of the umbilical arterial or venous catheter was determined by 2-dimensional echocardio/aortography in 55 consecutive infants and was compared to localization by thoraco-abdominal roentgenography. Most of the infants (76%) had respiratory distress syndrome or congenital heart disease. Echocaortographic localization of the umbilical arterial catheter correlated very closely (N = 50, sr = .90) with roentgenographic determination. For localization of the tip of the umbilical venous catheters, echocardiography was more accurate than roentgenography (employing contrast echocardiography for confirmation of cardiac chamber position). Two-dimensional echocardio/aortographic localization of the tip of indwelling umbilical vascular catheters is as accurate as roentgenography in the arterial system and more accurate than x-ray for umbilical venous catheters. Echocardio/aortography is superior to roentgenography (in localizing the catheter tip) because it 1) avoids ionizing radiation, 2) makes positioning of the patient unnecessary, 3) allows visualization of the catheter in relation to cardiovascular structures, and 4) may allow demonstration of intraarterial thrombo-emboli.

Umbilical venous catheter position: evaluation by ultrasound

“…The last portion of this complex course runs in the sagittal plane, therefore is not visualized properly on the AP view on standard radiograph; thus several studies have questioned the usefulness of radiograph to evaluate catheter position. Ultrasonography has been suggested as an aid to evaluation catheter placement [4][5][6][7][8][9][10].…”

Ultrasound-guided umbilical catheter insertion in neonates

“…Therefore, some studies strongly suggest that ultrasound with direct visualization of the inserted catheter should be considered the gold standard to confirm correct catheter placement. [3][4][5] Several studies have questioned the current methods used for estimating umbilical catheter insertion length. Lopriore et al 6 questioned 101 pediatric professionals from 6 centers in the Netherlands and found that the method used by the participants to measure the shoulder-umbilicus length was highly inconsistent, with only 14% using the described measurement.…”

Echocardiographic Evaluation of Umbilical Venous Catheter Placement

“…17,18 Some studies have suggested that echocardiography with saline ''contrast'' injection to document distal catheter location should be the ''gold standard'' to confirm correct UVC placement. 15,16 However, many of these studies have a limited number of patients and do not compare the traditional methods of assessing catheter tip position to echocardiography. The purpose of this study is to evaluate prospectively the validity of the traditional tools for prediction of anatomic location after UVC insertion using echocardiography with saline injection to document definitively anatomic catheter location.…”