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D'Andrea V, Prontera G, Pinna G, Cota F, Fattore S, Costa S, Migliorato M, Barone G, Pittiruti M, Vento G. Securement of Umbilical Venous Catheter Using Cyanoacrylate Glue: A Randomized Controlled Trial. J Pediatr 2023; 260:113517. [PMID: 37244573 DOI: 10.1016/j.jpeds.2023.113517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the role of cyanoacrylate glue in reducing dislodgement of umbilical venous catheters (UVCs). STUDY DESIGN This was a single-center, randomized, controlled, nonblinded trial. All infants requiring an UVC according to our local policy were included in the study. Infants with a UVC with a centrally located tip as verified by real-time ultrasound examination were eligible for the study. Primary outcome was the safety and efficacy of securement by cyanoacrylate glue plus cord-anchored suture (SG group) vs securement by suture alone (S group), as measured by reduction in dislodgment of the external tract of the catheter. Secondary outcomes were tip migration, catheter-related bloodstream infection, and catheter-related thrombosis. RESULTS In the first 48 hours after UVC insertion, dislodgement was significantly higher in the S group than in the SG group (23.1% vs 1.5%; P < .001). The overall dislodgement rate was 24.6% in the S group vs 7.7% in the SG group (P = .016). No differences were found in catheter-related bloodstream infection and catheter-related thrombosis. The incidence of tip migration was similar in both groups (S group 12.2% vs SG group 11.7%). CONCLUSIONS In our single-center study, cyanoacrylate glue was safe and effective for securement of UVCs, and particularly effective in decreasing early catheter dislodgments. TRIAL REGISTRATION UMIN-CTR Clinical Trial; Registration number: R000045844.
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Affiliation(s)
- Vito D'Andrea
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Giorgia Prontera
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Pinna
- Neonatal Intensive Care Unit, Maternal-Fetal Department, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Francesco Cota
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Simona Fattore
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Simonetta Costa
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Martina Migliorato
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, AUSL Romagna, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Torres Del Pino M, Gómez Santos E, Domínguez Quintero ML, Mendoza Murillo B, Millán Zamorano JA, Toledo Muñoz-Cobo G, Mora Navarrocor D. Steps to improve umbilical vein catheterization in neonatal care. An Pediatr (Barc) 2023; 99:155-161. [PMID: 37658020 DOI: 10.1016/j.anpede.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/21/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION In neonatal units, umbilical vessel catheterization is the preferred method to gain vascular access in the initial management of the newborn because it is quick and easy. The failure rate ranges from to 50%, as the catheter can be found in the portal system in up to 40% of cases, leading to complications. This failure rate warrants the investigation of different methods to reduce the frequency of catheter malposition. We describe different techniques to improve the success rate in umbilical vein catheterization, such as the double catheter technique, positioning the newborn in right lateral decubitus for insertion, liver compression, and ultrasound-guided catheter insertion. The primary objective of the study was to assess the impact of new techniques on the success rate of central umbilical venous catheterization. MATERIAL AND METHODS Pre- and post-intervention quasi-experimental study in a level B NICU conducted in January-June 2022 (pre-intervention) and July-December 2022 (post-intervention). RESULTS Prior to the introduction of these new catheterization techniques, the failure rate of blind umbilical catheter insertion was 52%. Since the introduction of these measures, the overall failure rate has decreased to 27%. CONCLUSIONS After the introduction of the new catheterization and recanalization methods, our success rate in umbilical vein catheterization has increased, and we believe it is necessary to implement them in units with similar failure rates to ours.
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Affiliation(s)
- Marta Torres Del Pino
- Unidad de Neonatología, Servicio de Pediatría, Hospital Juan Ramón Jiménez, Huelva, Spain.
| | - Elisabet Gómez Santos
- Unidad de Neonatología, Servicio de Pediatría, Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | | | | | | | - David Mora Navarrocor
- Unidad de Neonatología, Servicio de Pediatría, Hospital Juan Ramón Jiménez, Huelva, Spain
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Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease. Pediatr Crit Care Med 2022; 23:e257-e266. [PMID: 35250003 DOI: 10.1097/pcc.0000000000002919] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Umbilical venous cannulation is the favored approach to perinatal central access worldwide but has a failure rate of 25-50% and the insertion technique has not evolved in decades. Improving the success of this procedure would have broad implications, particularly where peripherally inserted central catheters are not easily obtained and in neonates with congenital heart disease, in whom umbilical access facilitates administration of inotropes and blood products while sparing vessels essential for later cardiac interventions. We sought to use real-time, point-of-care ultrasound to achieve central umbilical venous access in patients for whom conventional, blind placement techniques had failed. DESIGN Multicenter case series, March 2019-May 2021. SETTING Cardiac and neonatal ICUs at three tertiary care children's hospitals. PATIENTS We identified 32 neonates with congenital heart disease, who had failed umbilical venous cannulation using traditional, blind techniques. INTERVENTIONS Real-time ultrasound guidance and liver pressure were used to replace malpositioned catheters and achieve successful placement at the inferior cavoatrial junction. MEASUREMENTS AND MAIN RESULTS In 32 patients with failed prior umbilical venous catheter placement, real-time ultrasound guidance was used to successfully "rescue" the line and achieve central position in 23 (72%). Twenty of 25 attempts (80%) performed in the first 48 hours of life were successful, and three of seven attempts (43%) performed later. Twenty-four patients (75%) were on prostaglandin infusion at the time of the procedure. We did not identify an association between patient weight or gestational age and successful placement. CONCLUSIONS Ultrasound guidance has become standard of care for percutaneous central venous access but is a new and emerging technique for umbilical vessel catheterization. In this early experience, we report that point-of-care ultrasound, together with liver pressure, can be used to markedly improve success of placement. This represents a significant advance in this core neonatal procedure.
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Kishigami M, Shimokaze T, Enomoto M, Shibasaki J, Toyoshima K. Ultrasound-Guided Umbilical Venous Catheter Insertion With Alignment of the Umbilical Vein and Ductus Venosus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:379-383. [PMID: 31400014 DOI: 10.1002/jum.15106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 06/10/2023]
Abstract
Previous studies have highlighted the importance of confirming the position of an umbilical venous catheter (UVC) tip by an ultrasound (US) examination. However, methods for preventing insertion into the portal circulation under US guidance have not yet been established. We report 15 cases in which a UVC was successfully passed through the ductus venosus by compressing the upper abdomen near the portal sinus of the liver to align the umbilical vein and ductus venosus under US guidance. The UVC was inserted into the correct position in 14 of the 15 neonates (93%) without complications.
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Affiliation(s)
- Makoto Kishigami
- Kanagawa Children's Medical Center, Kanagawa, Japan
- Takatsuki General Hospital, Osaka, Japan
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Kieran EA, Laffan EE, O'Donnell CP. Positioning newborns on their back or right side for umbilical venous catheter insertion. Acta Paediatr 2016; 105:e443-7. [PMID: 27411081 DOI: 10.1111/apa.13525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022]
Abstract
AIM Newborns are placed supine for umbilical venous catheter insertion, and catheter tip position is confirmed with X-ray. Umbilical venous catheters are considered correctly positioned when the tip is in the inferior vena cava; however, frequently, the catheter tip enters the portal venous circulation. We wished to determine whether placing infants on their right side, rather than on the back, for umbilical venous catheter insertion results in more correctly placed catheters. METHODS Newborns were randomised to be placed on their back, or turned onto their right side for catheter insertion. Primary outcome was correct catheter tip position on X-ray (visible in the midline at diaphragm level). RESULTS Umbilical venous catheter insertion was successful in all infants enrolled. There was no difference in the proportion of correctly positioned catheters between the groups [back 23/44 (52%) versus right side 27/44 (61%), p = 0.389]. More infants randomised to back had the catheter tip in the portal circulation [back 13/44 (30%) versus right side 5/44 (11%), p = 0.034]. CONCLUSION 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.
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Affiliation(s)
- Emily A. Kieran
- Department of Neonatology; The National Maternity Hospital; Dublin Ireland
- National Children's Research Centre; Dublin Ireland
- School of Medicine; University College Dublin; Dublin Ireland
| | - Eoghan E. Laffan
- Department of Radiology; The National Maternity Hospital; Dublin Ireland
| | - Colm P.F. O'Donnell
- Department of Neonatology; The National Maternity Hospital; Dublin Ireland
- National Children's Research Centre; Dublin Ireland
- School of Medicine; University College Dublin; Dublin Ireland
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Kieran EA, Laffan EE, O'Donnell CPF. Estimating umbilical catheter insertion depth in newborns using weight or body measurement: a randomised trial. Arch Dis Child Fetal Neonatal Ed 2016; 101:F10-5. [PMID: 26265678 DOI: 10.1136/archdischild-2014-307668] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 07/13/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Incorrectly positioned umbilical venous and arterial catheters (UVC and UAC) are associated with increased rates of complications in newborns. Catheter insertion depth is often estimated using body surface measurement. We wished to determine whether estimating insertion depth of umbilical catheters using birth weight (BW), rather than surface measurements, results in more correctly positioned catheters. INTERVENTIONS/OUTCOME Newborns were randomised to have UVC and UAC insertion depth estimated using formulae based on BW or using graphs based on shoulder-umbilicus length. The primary outcome was correct catheter tip position on X-ray determined by one radiologist masked to group assignment. RESULTS UVC insertion was successful in 97/101 (96%) infants but the catheter was not advanced to the estimated depth in 22. There was no difference in the proportion of correctly positioned UVCs between groups (weight 16/51 (31%) vs measurement 13/46 (28%), p=0.826). The tips of 52 (54%) UVCs were in the portal venous system or too low on X-ray. Attempted UAC insertion was successful in 62/87 (71%) infants. More infants in the weight group had a correctly positioned UAC tip (weight 29/32 (91%) vs measurement 15/30 (50%), p=0.001). CONCLUSIONS UVCs were often not inserted to the estimated depth, and their tips were in the portal venous system or too low on X-ray. Using BW to estimate insertion depth did not result in more correctly positioned UVCs. UAC insertion attempts were often unsuccessful, but when successful, using BW to estimate insertion depth resulted in more correctly positioned catheters. TRIAL REGISTRATION NUMBER (ISRCTN17864069).
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Affiliation(s)
- Emily A Kieran
- Department of Neonatology, The National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
| | - Eoghan E Laffan
- Department of Radiology, The National Maternity Hospital, Dublin, Ireland
| | - Colm P F O'Donnell
- Department of Neonatology, The National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
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DeWitt AG, Zampi JD, Donohue JE, Yu S, Lloyd TR. Fluoroscopy-guided Umbilical Venous Catheter Placement in Infants with Congenital Heart Disease. CONGENIT HEART DIS 2014; 10:317-25. [PMID: 25399854 DOI: 10.1111/chd.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to (1) describe the technical aspects of fluoroscopy-guided umbilical venous catheter placement (FGUVCP); and (2) determine the procedural success rate, factors contributing to procedural failure, and risks of the procedure. BACKGROUND Umbilical venous catheters are advantageous compared with femoral venous access, but can be difficult to place at the bedside. MATERIALS AND METHODS This was a retrospective chart review from a single tertiary care referral institution. RESULTS FGUVCP was successful in 138 of 180 patients (76.7%) over a seven-year period. Patients in whom FGUVCP was successful were younger at the time of procedure compared with patients in whom FGUVCP was unsuccessful (median 18.2 vs. 22.2 hours, P = .03). The optimal age cutoff to predict FGUVCP success was 20 hours with a high positive predictive value (82.4%) but low negative predictive value (32.5%). No other variables were associated with procedural failure, though functional univentricular heart and older gestational age trended toward statistical significance. Median radiation time, contrast exposure, and blood loss were 3.2 minutes, 1 mL, and 1 mL, respectively. A total of 10 complications in 10 patients were associated with FGUVCP. CONCLUSIONS FGUVCP is a safe and highly successful way to obtain central venous access in neonates with congenital heart disease. Older age at the time of procedure is associated with procedural failure, but utilization of an age cutoff may not be clinically useful.
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Affiliation(s)
- Aaron G DeWitt
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Jeffrey D Zampi
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Janet E Donohue
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Sunkyung Yu
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Thomas R Lloyd
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
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Abstract
Umbilical arterial and venous catheter placement have become the standard of care in the neonatal intensive care unit. These catheters allow for rapid and reliable vascular access for the administration of fluids and medications, as well as a means for accurate laboratory determinations and invasive monitoring. Catheter placement and maintenance require training and education of all healthcare workers to prevent or minimize the associated risks.
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Affiliation(s)
- Patricia Nash
- Cardinal Glennon Children's Medical Center, St. Louis, Missouri, USA
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Abstract
BACKGROUND In the neonate, umbilical venous catheters (UVC) are inserted and advanced blindly to a predetermined length from the umbilicus. The reported rates for UVC misplacement into the liver (and occasionally the spleen) range from 20 to 37%. Radiographs are routinely used to confirm the positioning of UVCs. This involves movement of often critically ill infants, as well as radiation exposure. This pilot study examines the potential value of confirming UVC placement in neonates using ECG. METHODS In critically ill neonates, a conductive Johans ECG adapter was connected to a UVC. A satisfactory tracing (lead II) was obtained (right arm lead connected to the adapter) when the UVC was filled with saline solution allowing the catheter tip to become a unipolar ECG electrode. The UVC was then advanced from the umbilicus until the tip reached the inferior vena cava (IVC) within the thoracic region, as demonstrated by appearance of normal sized QRS complexes with small P-waves. A small QRS indicated the catheter was below the diaphragm. The appearance of a tall positive P-wave indicated the tip was at the right atrium level. The UVC was then withdrawn until the P-wave size returned to normal. The final UVC position was later confirmed by X-ray. RESULTS Eight neonates were studied. The figure shows typical ECG tracings when the UVC was placed in the liver, IVC, and right atrium, respectively. Three malpositioned catheters were detected (2 into liver and 1 into spleen). CONCLUSIONS Based on these cases, the insertion of UVCs in neonates can be guided with ECG by observing sequential and characteristic alterations in P-waves and QRS complexes, thereby reducing the use of X-rays. In addition, this technique could prove to be beneficial in remote healthcare facilities where X-ray machines may not be readily available and quick intravenous access is required to transport sick neonates to major centers.
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Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital and Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Al-Essa M, Rashwan N, Devarajan LV. Double-catheter technique for the proper insertion of umbilical venous catheters in newborns. Med Princ Pract 2005; 14:98-101. [PMID: 15785101 DOI: 10.1159/000083919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Accepted: 03/21/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To document the usefulness and safety of inserting a second umbilical venous catheter in ill neonates, while a previously misplaced first catheter was still in its place. SUBJECTS AND METHODS The case series involved 25 newborn babies who were admitted to the Neonatal Intensive Care Unit, Maternity Hospital, Kuwait, over a 3-year period from 1999 to 2002. The umbilical venous catheter of the babies was misplaced and diverted to the liver, necessitating insertion of a second catheter while the previous one was still in place. The characteristics of the babies and possible catheter-related complications were recorded. RESULTS Of the 25 babies, 19 had the second catheter properly placed in the right atrium, while in the remaining 6 neonates, the catheter was still misplaced. Misplacement occurred mostly in full-term babies or the catheter was inserted at a later stage. No life-threatening complication was observed during the procedure. CONCLUSION Insertion of a second umbilical venous catheter with the misplaced first catheter in situ is a useful and safe procedure.
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Affiliation(s)
- Mazen Al-Essa
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait.
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