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

Abstract

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.

Comparison of Ultrasound-Guided Umbilical Venous Catheter Insertion with Blind Method: A Randomized Controlled Trial

“…Median (IQR) birth weights were 1,672 (1,060-2,365) and 1,445 g (1,020-2,245) in USG and blind groups, respectively. The age of neonate (median [IQR]) at the insertion of the umbilical line was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) hours in the USG group and 2 (2-12) hours in the blind group. The remaining baseline characteristics were comparable in both groups (Table 1).…”

“…Limited studies are available using USG to confirm the correct position of the UVC in neonates [7,8,[10][11][12][13][14][15][16]. Most studies except one [16] are observational studies with a small sample size.…”

Umbilical Vein Calcification Associated with Double-Lumen Catheter Malpositioning in an Extremely Low-Birth-Weight Infant

“…In the lateral view, it can be suitably visualized [30]. Some authors advocate bedside US, which is convenient, non-invasive, and radiation-free and allows real-time guidance of UVC [31][32][33], as the gold standard for verification of the position of the UVC [34,35]. Moreover, Lafortune reported that the DV was visible upon US in the first hours after birth as a small vein coursing posteriorly and cephalically from the umbilical portion of the left PV [36].…”

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study

“…Point-of-care ultrasound (POCUS) is a convenient, non-invasive modality that does not require radiation exposure. It can guide UVC in real time and monitor the catheter tip position ( 5 ). Early detection of catheter tip displacement can effectively prevent arrhythmia, pericardial effusion ( 6 ), pericardial tamponade ( 7 ), endocarditis, pleural effusion ( 8 ), liver hemorrhage, liver tissue necrosis ( 9 ), and other serious complications.…”