1
|
D'Andrea V, Prontera G, Cota F, Perri A, Russo R, Barone G, Vento G. Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Umbilical Venous Catheter Placement in Neonates: A Retrospective, Observational Study. Neonatology 2024:1-6. [PMID: 38934171 DOI: 10.1159/000538905] [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: 02/10/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The umbilical venous catheter is a vital access device in neonatal intensive care units for preterm and critically ill infants. Correct positioning is crucial, as malpositioning can lead to severe complications. According to international guidelines, the position of the umbilical venous catheter tip must be assessed in real time; traditionally, the catheter is visualized with a thoracoabdominal X-ray, but one of the most effective and safest methods is therefore real-time ultrasound. METHODS This study compares real-time ultrasound and traditional X-ray methods for assessing umbilical venous catheter tip location in 461 cases. The rate of tip malposition was analyzed retrospectively. The secondary aim was to assess indwelling time of umbilical venous catheters and reasons of removal. RESULTS Real-time ultrasound tip location, found to be more reliable and efficient, demonstrated a significantly lower incidence of primary malpositioning compared to X-ray assessments (9.6 vs. 75.9%). The study also highlighted the association of real-time ultrasound with reduced catheter manipulation, fewer radiographs, and higher indwelling times of umbilical venous catheter. The multiple logistic regression showed a high probability of the central safe position of the umbilical venous catheter tip using real-time ultrasound tip location (odds ratio 29.5, 95% confidence interval: 17.4-49.4). CONCLUSION The findings support the adoption of real-time ultrasound in clinical settings to enhance umbilical venous catheter placement accuracy and minimize associated risks. A minimal training investment is needed to attain the proficiency to visualize the umbilical venous catheters, offering a substantial advantage in terms of both cost-effectiveness for the procedure and enhanced patient safety.
Collapse
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
| | - Francesco Cota
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| |
Collapse
|
2
|
Cao J, Zhang Y, Yin Y, Liu Y. Accuracy of chest radiography compared to ultrasound for positioning the umbilical venous catheter in neonates: A meta-analysis and systematic review. J Vasc Access 2023; 24:1051-1060. [PMID: 34784827 DOI: 10.1177/11297298211046755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This study was aimed to investigate the accuracy of anteroposterior chest radiography for tip position verification for the umbilical venous catheters in neonates compared to ultrasound. A search in the PubMed, Embase, the Cochrane Library, and EBSCO was conducted to evaluate all the related articles on umbilical venous catheter (UVC), ultrasound AND neonates updated to August, 2020. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random effects model was used to estimate the pooled sensitivity, specificity, and diagnostic odds ratio (DOR). The summary receiver operator characteristic (SROC) curve was constructed, and the area under the SROC curve (AUC) was calculated. Fourteen related studies were finally included for meta-analysis. The overall diagnostic sensitivity and specificity of X-ray on tip verification of UVC were 0.90 (95% CI 0.71-0.97) and 0.82 (95% CI 0.53-0.95), respectively. The pooled DOR was 3.69 (95% CI 1.64-5.71). The AUC was 0.93 (95% CI 0.90-0.95). The meta-regression analysis suggested that study sample size, study design, different US confirming method, and different gold standard in original design might be potential sources of heterogeneity. Our conclusion is that the commonly used anteroposterior X-ray is not reliable in identifying the exact anatomical location of UVC tip in neonates. Studies suggested ultrasound or echocardiography with saline contrast injection could be the gold standard for verification of catheter location and should be considered whenever possible, especially in premature patients. More studies are needed to expand the use of ultrasound or echocardiography in tip position confirming of UVCs.
Collapse
Affiliation(s)
- Juan Cao
- Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yuzheng Zhang
- Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yanling Yin
- School of Nurinsg, Weifang Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nurinsg, Weifang Medical University, Weifang, China
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Gibson K, Sharp R, Ullman A, Morris S, Kleidon T, Esterman A. Adverse events associated with umbilical catheters: a systematic review and meta-analysis. J Perinatol 2021; 41:2505-2512. [PMID: 34272469 DOI: 10.1038/s41372-021-01147-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the incidence of adverse events (AEs) associated with umbilical catheters in the neonatal population. STUDY DESIGN Systematic review and meta-analysis of observational studies and randomized controlled trials published between 2010 and 2020. RESULTS In total 14,226 umbilical venous catheters (UVCs) and 4228 umbilical arterial catheters (UACs) were included. Overall, 13.4% of UVCs were associated with an AE (95% CI: 10.1-17.0) or 2.4 per 1000 catheter days (95% CI: 1.8-3.0). UACs had an AE rate of 9% (95% CI: 5.9-12.8) or 0.87 per 1000 catheter days (95% CI: 0.4-1.3). UVC malposition was the most common (41.7% [95% CI: 27.6-56.5]). Local injury from UAC taping was the most common AE in one study. CONCLUSIONS Umbilical catheters have a high incidence of AEs. Research into accurate methods of tip verification, tip surveillance, and securement is required.
Collapse
Affiliation(s)
- Kim Gibson
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Rebecca Sharp
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Amanda Ullman
- Children's Health Queensland and Health Service, Centre of Children's Health Research, South Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Scott Morris
- Neonatal Unit, Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tricia Kleidon
- Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Adrian Esterman
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
- Makoto Kishigami
- Kanagawa Children's Medical Center, Kanagawa, Japan
- Takatsuki General Hospital, Osaka, Japan
| | | | | | | | | |
Collapse
|
7
|
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.
Collapse
|
8
|
O'Riordan AM, Kozdoba O, Murphy JFA, McCarthy LK. Magnifying lenses to aid umbilical catheter insertion. Acta Paediatr 2018; 107:1469-1470. [PMID: 29683522 DOI: 10.1111/apa.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aisling M O'Riordan
- Department of Neonatology; The National Maternity Hospital; Dublin 2 Ireland
| | - Oksana Kozdoba
- Department of Neonatology; The National Maternity Hospital; Dublin 2 Ireland
| | - John FA Murphy
- Department of Neonatology; The National Maternity Hospital; Dublin 2 Ireland
| | - Lisa K McCarthy
- Department of Neonatology; The National Maternity Hospital; Dublin 2 Ireland
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation. RECENT FINDINGS Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs. SUMMARY Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.
Collapse
|