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Zubi ZBH, Abdullah AFB, Helmi MABM, Hasan TH, Ramli N, Ali AAABM, Mohamed MAS. Indications, Measurements, and Complications of Ten Essential Neonatal Procedures. Int J Pediatr 2023; 2023:3241607. [PMID: 37705709 PMCID: PMC10497369 DOI: 10.1155/2023/3241607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.
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Affiliation(s)
- Zainab Bubakr Hamad Zubi
- Department of Paediatrics, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Ahmad Fadzil Bin Abdullah
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Muhd Alwi Bin Muhd Helmi
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Taufiq Hidayat Hasan
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Noraida Ramli
- Department of Paediatrics, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Mossad Abdelhak Shaban Mohamed
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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Barone G, D'Andrea V, Ancora G, Cresi F, Maggio L, Capasso A, Mastroianni R, Pozzi N, Rodriguez-Perez C, Romitti MG, Tota F, Spagnuolo F, Raimondi F, Pittiruti M. The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns. Eur J Pediatr 2023; 182:3385-3395. [PMID: 37195350 DOI: 10.1007/s00431-023-04984-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/18/2023]
Abstract
In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice. Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy.
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Sant'Anna Hospital, University of Turin, Città Della Salute E Della Scienza, Turin, Italy
| | - Luca Maggio
- Neonatology and Neonatal Intensive Care Unit, AO San Camillo Forlanini, Rome, Italy
| | - Antonella Capasso
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | | | - Nicola Pozzi
- Neonatal Intensive Care Unit, San Pio Hospital, Benevento, Italy
| | - Carmen Rodriguez-Perez
- Neonatology and Neonatal Intensive Care Unit, ASST Spedali Civili, Ospedale Dei Bambini, Brescia, Italy
| | | | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, AOU Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Raimondi
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Soonsawad S, Kieran EA, Ting JY, AlonsoPrieto E, Panczuk JK. Factors Associated with Umbilical Venous Catheter Malposition in Newborns: A Tertiary Center Experience. Am J Perinatol 2022; 39:1805-1811. [PMID: 33853146 DOI: 10.1055/s-0041-1726385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Umbilical venous catheters (UVC) are widely used in neonatal intensive care (NICU). Noncentral catheter position is known to be associated with multiple adverse complications; however, risk factors for catheter malposition are unclear. This work aimed to identify clinical risk factors and complications associated with UVC malposition in neonates admitted in an NICU. STUDY DESIGN A retrospective chart review was performed of inborn babies admitted to BC Women's Hospital NICU with UVC inserted in their first 7 days between July 2016 and June 2018. Infant and maternal demographic, radiograph, UVC-related data, and complications were reviewed. RESULTS A total of 257 infants had UVC placed; 158 (61%) and 99 (39%) were in central and noncentral positions after initial placement, respectively. Of initially central-placed UVCs, a further 35 (22%) were pulled back or migrated to malposition on follow-up X-ray. Multivariable logistic regression analysis revealed the use of larger UV (5 Fr) catheter (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.1-5.6, p = 0.026) and escalation of respiratory support mode (OR: 1.7, 95% CI: 1.0-2.8, p = 0.049) as significant predictors of catheter malposition. CONCLUSION Noncentral UVC position as well as migration were common after initial placement in this cohort. The use of larger size UV catheters and increasingly invasive respiratory support were risk factors associated with higher incidence of UVC malposition. Ongoing surveillance of UVC position is thus recommended. KEY POINTS · More than one-third of UV catheters were not in central position after the initial placement.. · Large size UV catheters and increasingly invasive respiratory support were risk factors for UV malposition.. · High incidence of UVC migration was found after initial central placement, warranting surveillance..
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Affiliation(s)
- Sasivimon Soonsawad
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.,Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Emily A Kieran
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
| | - Joseph Y Ting
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Esther AlonsoPrieto
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Julia K Panczuk
- Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
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Tanimoto A, Chapman T, Otjen JP, Stanescu AL. The undulating line sign and other more common pediatric central catheter malpositions. Pediatr Radiol 2022; 52:1381-1391. [PMID: 35362762 DOI: 10.1007/s00247-022-05303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/17/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
Central venous and arterial catheters are among the most commonly assessed support devices by radiologists. The position of these catheters must be carefully assessed to ensure proper placement, as malpositioning may lead to life-threatening consequences. Therefore, it is important for radiologists to understand the anatomy of the central vessels and the expected location of catheters. While this can be difficult in small children and especially in neonates, knowledge of the expected course and ideal termination of catheters allows for recognition of a malpositioned line, which may be unsuspected clinically. The purpose of this article is to discuss appropriate positioning of central catheters in pediatric patients, focusing primarily on venous catheters. We also propose a new radiographic sign to recognize, the undulating line sign, as an indication of an inappropriate course of a newly placed venous catheter.
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Affiliation(s)
- Aki Tanimoto
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. .,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
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Bersani I, Piersigilli F, Iacona G, Savarese I, Campi F, Dotta A, Auriti C, Di Stasio E, Garcovich M. Incidence of umbilical vein catheter-associated thrombosis of the portal system: A systematic review and meta-analysis. World J Hepatol 2021; 13:1802-1815. [PMID: 34904047 PMCID: PMC8637679 DOI: 10.4254/wjh.v13.i11.1802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of umbilical venous catheters (UVCs) in the perinatal period may be associated with severe complications, including the occurrence of portal vein thrombosis (PVT).
AIM To assess the incidence of UVC-related PVT in infants with postnatal age up to three months.
METHODS A systematic and comprehensive database searching (PubMed, Cochrane Library, Scopus, Web of Science) was performed for studies from 1980 to 2020 (the search was last updated on November 28, 2020). We included in the final analyses all peer-reviewed prospective cohort studies, retrospective cohort studies and case-control studies. The reference lists of included articles were hand-searched to identify additional studies of interest. Studies were considered eligible when they included infants with postnatal age up to three months with UVC-associated PVT. Incidence estimates were pooled by using random effects meta-analyses. The quality of included studies was assessed using the Newcastle-Ottawa scale. The systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS Overall, 16 studies were considered eligible and included in the final analyses. The data confirmed the relevant risk of UVC-related thrombosis. The mean pooled incidence of such condition was 12%, although it varied across studies (0%-49%). In 15/16 studies (94%), diagnosis of thrombosis was made accidentally during routine screening controls, whilst in 1/16 study (6%) targeted imaging assessments were carried out in neonates with clinical concerns for a thrombus. Tip position was investigated by abdominal ultrasound (US) alone in 1/16 (6%) studies, by a combination of radiography and abdominal US in 14/16 (88%) studies and by a combination of radiography, abdominal US and echocardiography in 1/16 (6%) studies.
CONCLUSION To the best of our knowledge, this is the first systematic review specifically investigating the incidence of UVC-related PVT. The use of UVCs requires a high index of suspicion, because its use is significantly associated with PVT. Well-designed prospective studies are required to assess the optimal approach to prevent UVC-related thrombosis of the portal system.
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Affiliation(s)
- Iliana Bersani
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Fiammetta Piersigilli
- Department of Neonatology, Cliniques Universitaires Saint Luc, Universitè Catholique de Louvain, Bruxelles 1200, Belgium
| | - Giulia Iacona
- Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Immacolata Savarese
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Francesca Campi
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Andrea Dotta
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Cinzia Auriti
- Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Enrico Di Stasio
- Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Gibson K, Sharp R, Ullman A, Morris S, Kleidon T, Esterman A. Risk factors for umbilical vascular catheter-related adverse events: A scoping review. Aust Crit Care 2021; 35:89-101. [PMID: 34088575 DOI: 10.1016/j.aucc.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Adverse events associated with umbilical catheters include malposition, bloodstream infections, thrombosis, tip migration, and extravasation, resulting in loss of vascular access and increased risk of morbidity and mortality. There is a need for greater understanding of risk factors associated with adverse events to inform safe practice. OBJECTIVES The aim of the study was to summarise the existing evidence regarding risk factors for umbilical catheter-related adverse events to inform the undertaking of future research. REVIEW METHOD USED A scoping review of peer-reviewed original research and theses was performed. DATA SOURCES The US National Library of Medicine National Institutes of Health, Embase, EMcare, and ProQuest Dissertations and Theses were the data sources. REVIEW METHODS Informed by the Joanna Briggs Institute Reviewer's Manual, all types of original research studies reporting adverse events published in English from 2009 to 2020 were eligible for inclusion. Studies where umbilical artery catheter and umbilical venous catheter data could not be extracted separately were excluded. RESULTS Searching identified 1954 publications and theses, 1533 were excluded at screening, and 418 were assessed for eligibility at full text. A total of 89 studies met the inclusion criteria. A range of potential risk factors for umbilical arterial and venous catheters were identified. Longer dwell time and prematurity were associated with increased risk of bloodstream infection and thrombosis in cohort studies. Case studies detailed analogous factors such as insertion techniques and lack of catheter surveillance during dwell warrant further investigation. CONCLUSIONS We identified a vast range of patient, device, and provider risk factors that warrant further investigation. There was a lack of large cohort studies and randomised controlled trials to demonstrate the significance of these risk factors. Improvement in methods to ensure correct catheter tip location and to detect adverse events early is essential. In addition, policy needs to be developed to guide clinicians in catheter surveillance measures to reduce the risk of adverse events.
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Affiliation(s)
- Kim Gibson
- Clinical and Health Sciences, University of South Australia, PO Box 2471, South Australia, 5000, Australia.
| | - Rebecca Sharp
- Clinical and Health Sciences, University of South Australia, PO Box 2471, South Australia, 5000, Australia.
| | - Amanda Ullman
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Nathan Campus, 170 Kessels Road Queensland 4111, Australia; Children's Health Queensland and Health Service Centre of Children's Health Research, South Brisbane QLD 4101, Australia; School of Nursing, Midwifery and Social Work The University of Queensland, Brisbane QLD 4072, Australia.
| | - Scott Morris
- College of Medicine and Public Health, Flinders University, Neonatal Unit, Flinders Medical Centre, Bedford Drive, Bedford Park, South Australia 5042, Australia.
| | - Tricia Kleidon
- Queensland Children's Hospital, 401 Stanley Street, South Brisbane, Q. 4101, Australia; School of Nursing and Midwifery, Griffith University, 170 Kessels Raod, Nathan, Q. 4111, Australia.
| | - Adrian Esterman
- Clinical and Health Sciences, University of South Australia, PO Box 2471, South Australia, 5000, Australia.
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Shabeer MP, Abiramalatha T, Gibikote S, Rebekah G, Thomas N. Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates - A Prospective Diagnostic Evaluation study. J Neonatal Perinatal Med 2021; 14:101-107. [PMID: 32310193 DOI: 10.3233/npm-200409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy and utility of bedside ultrasound (US) by neonatology residents to confirm position of umbilical venous catheter (UVC), umbilical arterial catheter (UAC), and peripherally inserted central catheter (PICC). METHODS In this prospective study, we included neonates who required UVC, UAC or PICC insertion. Two neonatology residents performed all bedside US examinations after a short period of training. Plain radiograph was taken as gold standard. Time taken for confirmation of catheter position by US and radiograph was recorded. RESULTS We recruited 71 neonates for UVC and UAC, and 40 neonates for PICC. Sensitivity and specificity of US in identifying a malpositioned catheter was good for UVC (94% and 66.7% respectively) and UAC (86.7% and 94.5%). Agreement between radiograph and US was good for UVC [0.718 (0.512, 0.861); p < 0.001] and UAC [0.857 (0.682, 0.953); p < 0.001]. Sensitivity (47.8%) of US in identifying a malpositioned PICC was low, though specificity (82.4%) was good. Agreement between radiograph and US in identifying PICC position was poor [0.25 (-0.084, 0.545); p 0.024]. This was due to incorrect interpretation of catheter position on radiograph in some infants, which was confirmed by the radiologist. The median time taken for US was significantly less than time taken for radiograph in confirming the position of UVC (50 vs. 155 minutes; p < 0.001)), UAC (45 vs. 128 minutes; p < 0.001), and PICC (60 vs. 136 minutes; p < 0.001). CONCLUSION US examination byneonatology residents has good diagnostic accuracy in confirming the position of UAC and UVC, and possibly PICC in neonates. The time taken to confirm catheter position by US is significantly less than radiograph.
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Affiliation(s)
- M P Shabeer
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - T Abiramalatha
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India.,Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - S Gibikote
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - G Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - N Thomas
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
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D'Andrea V, Prontera G, Rubortone SA, Pezza L, Pinna G, Barone G, Pittiruti M, Vento G. Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training. Front Pediatr 2021; 9:774705. [PMID: 35174113 PMCID: PMC8841780 DOI: 10.3389/fped.2021.774705] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022] Open
Abstract
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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Affiliation(s)
- Vito D'Andrea
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgia Prontera
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Serena Antonia Rubortone
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lucilla Pezza
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Pinna
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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9
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Chan KM, Chau JPC, Choi KC, Fung GPG, Lui WW, Chan MSY, Lo SHS. Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design. BMC Pediatr 2020; 20:445. [PMID: 32967637 PMCID: PMC7510280 DOI: 10.1186/s12887-020-02346-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.
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Affiliation(s)
- Kam Ming Chan
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong.,The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Genevieve Po Gee Fung
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong
| | - Wai Wa Lui
- Pharmacy Department, United Christian Hospital, Kowloon, Hong Kong
| | - Meme Suk Ying Chan
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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10
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Point-of-care ultrasound use in umbilical line placement: a review. J Perinatol 2020; 40:560-566. [PMID: 31758061 DOI: 10.1038/s41372-019-0558-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/16/2019] [Accepted: 11/08/2019] [Indexed: 11/08/2022]
Abstract
Point-of-care ultrasound (POCUS) has become a novel tool for assessing umbilical catheter tip location in the neonate. This review analyzes the current evidence on the efficacy and utility of POCUS for identifying umbilical catheter positioning. Medline, EMBASE, and Cochrane searches were performed until October 2018. Eight studies were identified comparing POCUS to x-ray in assessing umbilical catheter tip location in the last 10 years. POCUS was shown to be feasible and appears to be a superior imagining modality to x-rays in assessing umbilical line tip location. POCUS is more accurate in determining umbilical catheter positioning, allows for more rapid line umbilical catheter placement, and reduces the time to treatment as well as radiation exposure to the neonate when compared with x-ray. The available studies support further education in training neonatal providers to become proficient in POCUS for assessing umbilical lines.
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Umbilical catheter-associated complications in a level IV neonatal intensive care unit. J Perinatol 2020; 40:573-580. [PMID: 31911645 DOI: 10.1038/s41372-019-0579-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess complication rates and risks associated with the use of umbilical catheters. STUDY DESIGN An observational cohort study was conducted in a level IV neonatal intensive care unit over 11 years. Any neonate with an umbilical catheter placed during this period was included. Complication event rates over time were assessed via Poisson and Cox regressions. RESULTS Fifty one of 2035 umbilical arterial catheters (2.5%) and 269 of 2017 umbilical venous catheters placed (13.3%) developed a complication. Positional issues comprised most umbilical venous catheter-associated complications (86.2%) and breaks/ruptures the majority in umbilical arterial catheters (41.2%). The cumulative incidence of a complication increased most notably after 10 days of umbilical arterial catheter use and 16 days of umbilical venous catheter use. CONCLUSIONS Complications occurred in a relatively low percentage of umbilical catheters placed in our neonatal intensive care unit. Extended catheter dwell time remains a significant risk of developing a complication.
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Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience. Pediatr Neonatol 2020; 61:16-24. [PMID: 31186169 DOI: 10.1016/j.pedneo.2019.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 03/02/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
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 UVC-related 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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Selvam S, Humphrey T, Woodley H, English S, Kraft JK. Sonographic features of umbilical catheter-related complications. Pediatr Radiol 2018; 48:1964-1970. [PMID: 30078110 DOI: 10.1007/s00247-018-4214-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Umbilical catheters are commonly used in the neonatal period for blood sampling or for administering medication or parenteral nutrition. The position of the catheter is usually confirmed with radiography. However, many complications associated with the use of umbilical catheters, such as liver collections from extravasation or vascular thrombosis, are not apparent on radiographs but can be easily diagnosed with ultrasound. This pictorial review illustrates the sonographic findings of complications that should be excluded in the sick neonate with an indwelling catheter.
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Affiliation(s)
- Swathi Selvam
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK
| | - Terry Humphrey
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK
| | - Helen Woodley
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK
| | - Sharon English
- Department of Neonatology, Leeds Children's Hospital at Leeds General Infirmary, Leeds, UK
| | - Jeannette K Kraft
- Clarendon Wing Radiology Department, Leeds Children's Hospital at Leeds General Infirmary, Belmont Grove, Leeds, West Yorkshire, LS2 9NS, UK.
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Lee HM, Sung HJ, Lee HS. Umbilical Venous Catheter Complication Presenting as Chylous Ascites in a Newborn: Intraperitoneal Extravasation of Total Parenteral Nutrition Infusate. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.4.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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15
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Derinkuyu BE, Boyunaga OL, Damar C, Unal S, Ergenekon E, Alimli AG, Oztunali C, Turkyilmaz C. Hepatic Complications of Umbilical Venous Catheters in the Neonatal Period: The Ultrasound Spectrum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1335-1344. [PMID: 29034490 DOI: 10.1002/jum.14443] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Umbilical venous catheterization is commonly used in the neonatal period; however, it has some complications. In this study, we evaluated neonates who underwent umbilical venous catheterization and developed hepatic complications. Furthermore, we aimed to define all of the possible lesions and to clarify the imaging findings of umbilical venous catheter-induced hepatic injury. METHODS Two hundred forty-four neonates who underwent umbilical venous catheterization between March 2013 and September 2015 in a single tertiary care referral center were included in this study. To determine whether they had any hepatic complications, all patients underwent abdominal grayscale and Doppler ultrasound examinations, and their clinical data were recorded. RESULTS The frequency of liver-related complications from umbilical venous catheterization was 33.6% (82 of 244). Air in the portal venous system was the most frequent complication (20.1% [49 of 244]). Left portal venous thrombosis was noted in 6.1% (15 of 244). Parenchymal lesions in the liver related to umbilical venous catheterization were seen in 7.4% of patients (18 of 244) as follows: single nodular echogenic lesions (4.1% [10 of 244]), branching small nodular echogenic lesions (2.1% [5 of 244]), and large irregular heterogeneous lesions with laceration and perihepatic fluid (1.2% [3 of 244]). There was no statistical significance for any type of complication according to the gestational age (P > .05). CONCLUSIONS Hepatic complications due to umbilical venous catheters are not uncommon in the neonatal period. Ultrasound is the best imaging modality for confirming the diagnosis and for follow-up.
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Affiliation(s)
- Betul Emine Derinkuyu
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Oznur Leman Boyunaga
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cagri Damar
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sezin Unal
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Ergenekon
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Gul Alimli
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cigdem Oztunali
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Canan Turkyilmaz
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Shamir SB, Kurian J, Kogan-Liberman D, Taragin BH. Hepatic Imaging in Neonates and Young Infants: State of the Art. Radiology 2017; 285:763-777. [DOI: 10.1148/radiol.2017170305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stephanie B. Shamir
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Jessica Kurian
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Debora Kogan-Liberman
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Benjamin H. Taragin
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
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Abiramalatha T, Kumar M, Shabeer MP, Thomas N. Advantages of being diligent: lessons learnt from umbilical venous catheterisation in neonates. BMJ Case Rep 2016; 2016:bcr-2015-214073. [PMID: 26843419 DOI: 10.1136/bcr-2015-214073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Umbilical venous catheters (UVCs) are commonly used in neonatal units. Abdominal radiograph, taken soon after the insertion, is used to confirm the correct placement of the catheter. However, as demonstrated by our case series, complacency when an initial UVC is normally positioned can lead to detecting UVC-related complications very late. We describe cases of three neonates where, despite the initial UVC being confirmed to be well positioned, the patients developed life-threatening complications, including liver haematoma, left atrial thrombus and pericardial effusion causing cardiac tamponade. The routine use of point of care echocardiography helped in the early diagnosis of these complications. We suggest repeated echocardiographic screening at regular intervals in all newborn babies requiring UVCs, to ensure that the catheter is maintained in the proper position and for the early detection of catheter-related complications.
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Affiliation(s)
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
| | | | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
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Abstract
Neonates are unusually vulnerable to iatrogenic injury due to small body size, delicate tissues, and immature immune systems. Investigation of an unexpected neonatal death in the hospital should begin with a review of the medical record and discussion with medical staff involved in the patient׳s care. Postmortem investigation should include a complete and well-documented autopsy. Additional investigations, such as microbiological studies and chemical and toxicological studies of postmortem and antemortem fluid samples, may be crucial in arriving at a diagnosis. Causes of iatrogenic injury include birth trauma, medication errors and adverse drug effects, hospital-acquired infection, and medical device malfunction, incorrect placement, and misuse. Autopsy is an important tool for understanding the cause of an unexpected death, improving the quality of care, and providing closure to parents and family.
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Affiliation(s)
- Robyn C Reed
- Department of Laboratory Medicine and Pathology, University of Minnesota, C447 Mayo-MMC 76, 420 Delaware St SE, Minneapolis, MN 55455.
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