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Iakovidis A, Pierre K, Raviprasad A, Carvalho I, Zankevich A, Slater R, Sistrom C, Batmunh O, Sharma P, Mancuso A, Rajderkar D. Radiology resident proficiency in identifying misplaced lines, tubes, and devices: a simulation-based study using WIDI SIM. Emerg Radiol 2025; 32:73-78. [PMID: 39638911 DOI: 10.1007/s10140-024-02295-1] [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: 08/25/2024] [Accepted: 10/28/2024] [Indexed: 12/07/2024]
Abstract
PURPOSE Accurate placement of medical devices is crucial in critical care to prevent severe complications. This study aims to evaluate radiology residents' proficiency in identifying four specific critical misplacements of medical devices using the Wisdom in Diagnostic Imaging Simulation (WIDI SIM). METHODS A retrospective analysis was conducted on 1,102 responses from radiology residents who participated in the WIDI SIM between 2010 and 2022. The majority were first- and second-year residents from multiple institutions. The simulation presented four specific cases featuring misplacements of an endotracheal tube in the esophagus, an intrauterine device embedded in the myometrium, a peripherally inserted central catheter in the right internal jugular vein, and an umbilical venous catheter in the splenic vein. Residents provided free-text interpretations scored on a 0-10 scale by subspecialty radiologists. Errors were categorized as observational (failure to identify misplacement) or interpretive (misinterpretation of identified misplacement). Statistical analyses were performed using Kruskal-Wallis and Dunn's multiple comparisons tests. RESULTS Across all cases, residents' average scores did not meet the acceptable standard of 7 points. Observational errors were predominant, indicating a failure to recognize these specific device misplacements. Effective report rates were low: 58% for the endotracheal tube case, 35% for the intrauterine device, 19% for the peripherally inserted central catheter, and 25% for the umbilical venous catheter. Significant performance improvements were observed between first- and second-year residents in three of the four cases (p-values ranging from < 0.0001 to 0.0238), but overall proficiency remained suboptimal even among senior residents. CONCLUSION This study reveals gaps in radiology residents' ability to identify these specific misplaced lines, tubes, and devices accurately. The consistent pattern of underperformance, primarily due to observational errors, suggests a need for targeted educational interventions to improve resident proficiency in this aspect of emergency radiology.
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Anne RP, Rahiman EA, Aradhya AS. Real-time ultrasound for umbilical venous catheter insertion in neonates- a systematic review and meta-analysis. Ultrasound J 2025; 17:4. [PMID: 39804534 PMCID: PMC11730037 DOI: 10.1186/s13089-025-00406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 12/02/2024] [Indexed: 01/16/2025] Open
Abstract
OBJECTIVE There has been an increase in real-time ultrasonography use in central venous catheterisation. This systematic review and meta-analysis aimed to assess the role of real-time ultrasound use in umbilical venous catheterisation in neonates. DATA SOURCES PubMed, Embase, Web of Science and Cochrane Library were searched on July 11, 2024. We followed the Cochrane Handbook for Systematic Reviews of Interventions (for study conduct), GRADE methodology (for certainty of evidence), and PRISMA guidelines (for reporting). STUDY SELECTION All randomised controlled trials/RCTs and non-randomised studies of interventions/NRSIs comparing real-time ultrasound with the conventional technique of umbilical venous catheterisation were included. DATA EXTRACTION The outcomes of interest were malposition rates, procedure duration, mortality, sepsis, and cost. Data extraction and quality assessment were done in duplicate. DATA SYNTHESIS Six studies (three RCTs and three NRSI), including 863 participants, were included. Data were analysed separately for RCTs and NRSIs. The RCTs were at low risk of bias, but NRSIs were at moderate to serious risk. The pooled estimates from RCTs showed a decrease in malposition rates (2 studies, 165 participants, risk ratio/RR 0.45, 95% confidence interval/CI 0.23, 0.90) and procedure duration (3 studies, 196 participants, mean difference -6.1 min, 95% CI -8.4, -3.8 min) with real-time ultrasound use. There was no reduction in sepsis. Mortality was not reported. The certainty of evidence was low for malposition rates and procedure duration. The data from NRSIs showed a reduction in malposition rates (3 studies, 667 participants, risk ratio/RR 0.10, 95% confidence interval/CI 0.07, 0.14) without an impact on procedure duration and sepsis. However, these findings did not improve the evidence. CONCLUSIONS Low certainty evidence suggests that using real-time ultrasound for umbilical venous catheterisation reduces malposition rates. There is a clinically insignificant reduction in procedure duration. There is no sufficient data to come to a conclusion on the critical outcomes of sepsis and mortality. PROSPERO registration number: CRD42024567895.
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Affiliation(s)
- Rajendra Prasad Anne
- Department of Neonatology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Emine A Rahiman
- Department of Pediatric Oncology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Berger TD, Gavri A, Jesin S, Strauss T, Weiss B. Hepatic extravasation of total parenteral nutrition following umbilical venous catheter insertion: A rare complication. JPGN REPORTS 2024; 5:83-85. [PMID: 38545274 PMCID: PMC10964330 DOI: 10.1002/jpr3.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/26/2023] [Accepted: 12/05/2023] [Indexed: 11/10/2024]
Abstract
Umbilical venous catheters are commonly inserted in critically ill newborns and can lead to severe complications when misplaced. We report a preterm female with a prenatal diagnosis of duodenal atresia who presented 2 days after the surgical repair with abdominal distension, hemodynamic instability, elevated liver enzymes with severe cholestatic jaundice, and a hepatic collection on abdominal sonography. An urgent explorative laparotomy demonstrated a large amount of white, milky-appearing fluid in the abdominal cavity. Together with the sonographic findings, this led to the diagnosis of hepatic total parenteral nutrition extravasation. Upon removal of the umbilical venous catheter line, the infant's clinical state rapidly improved; however, cholestasis continued for months, with a very slow resolution. During follow-up, the liver enzymes normalized, and a complete resolution of the liver collection was observed, without drainage.
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Affiliation(s)
- Tal David Berger
- Division of Pediatric Gastroenterology and NutritionEdmond and Lily Safra Children's HospitalTel‐HashomerIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Ayelet Gavri
- Neonatology Department (Neonatal Intensive Care Unit)Edmond and Lily Safra Children's HospitalTel‐HashomerIsrael
| | - Stuart Jesin
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Tzipi Strauss
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Neonatology Department (Neonatal Intensive Care Unit)Edmond and Lily Safra Children's HospitalTel‐HashomerIsrael
| | - Batia Weiss
- Division of Pediatric Gastroenterology and NutritionEdmond and Lily Safra Children's HospitalTel‐HashomerIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
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Al-Dajani N, Osiovich H, Smyth J, Byrne A, Jamieson D, Kaczala G. Umbilical Venous Catheter Position: The Value of Acquiring a Lateral in Addition to a Frontal Chest Radiograph. Cureus 2023; 15:e46642. [PMID: 37808595 PMCID: PMC10560078 DOI: 10.7759/cureus.46642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Umbilical venous catheters (UVCs) are standardly used for central venous access in acutely sick neonates. Complications associated with UVCs include thrombosis, infection, diffuse intravascular coagulopathy, arrhythmia, tamponade, and liver injury, many of which are related to misplacement of the catheters. Therefore, this study aimed to institute a policy of obtaining lateral and frontal radiographs to improve the determination of the UVC position. Methods We retrospectively reviewed UVC placement from 132 radiographs. We compared interpretations by different reviewers of frontal versus frontal and lateral chest radiographs for the most accurate determination of the UVC position. The reviewers completed questionnaires indicating their assessment of the catheter tip position, as well as the appropriate catheter manipulation required for optimal positioning. Their assessment was derived from frontal chest radiographs followed by frontal plus lateral view radiographs a week later. Results The reviewers (junior neonatology fellow, senior neonatology fellow, pediatric radiology fellow, and senior pediatric radiologist) revised their assessment with regard to the UVC positioning between frontal and frontal plus lateral radiographs in 24.6%, 22.7%, 19.6%, and 15.9% of cases, respectively, and indicated that the lateral view was helpful in 18%, 13.6%, 19.6%, and 31% of the cases, respectively. UVCs were placed appropriately at the first attempt in only 13.6% of the cases. Conclusion Correct initial placement of a UVC is uncommon. A lateral radiograph is beneficial in determining the UVC position. Hence, we suggest the inclusion of a lateral view along with the frontal chest radiograph for the evaluation of the UVC position if real-time ultrasound cannot be performed before UVC usage.
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Affiliation(s)
- Nawaf Al-Dajani
- Pediatric Department, King Abdulaziz University, Jeddah, SAU
| | - Horacio Osiovich
- Pediatric Department, British Columbia Children & Women's Hospital, Vancouver, CAN
| | - John Smyth
- Pediatric Department, British Columbia Children & Women's Hospital, Vancouver, CAN
| | - Angela Byrne
- Radiology, Children's Health Ireland, Dublin, IRL
| | - Douglas Jamieson
- Radiology Department, British Columbia Children & Women's Hospital, Vancouver, CAN
| | - Gregor Kaczala
- Pediatric Intensive Care Unit, Praxiszentrum am Bahnhof Bern, Bren, CHE
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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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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: 8] [Impact Index Per Article: 4.0] [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.
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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
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Kim MJ, Yoo SY, Jeon TY, Kim JH, Kim YJ. Imaging of Umbilical Venous Catheter-Related Hepatic Complications in Neonates. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:586-595. [PMID: 37324991 PMCID: PMC10265250 DOI: 10.3348/jksr.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
An umbilical venous catheter (UVC) is commonly placed for central venous access in preterm or critically ill full-term neonates to provide total parenteral nutrition (TPN) and medication. However, UVCs can result in complications, including infection, portal vein thrombosis, and hepatic tissue injury. The inadvertent administration of hypertonic fluid through a malpositioned UVC can also cause hepatic parenchymal damage with mass-like fluid collection that simulates a tumorous condition during imaging. Ultrasonography and radiographic examinations play an essential role in detecting UVC-related complications. This pictorial essay aims to present the imaging findings of UVC-related hepatic complications in neonates.
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8
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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: 2] [Impact Index Per Article: 0.7] [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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Riedesel EL, Richer EJ, Taylor SD, Tao T, Gagnon MH, Braithwaite KA, Alazraki AL, Khanna G. Pediatric Hepatic Cystic Lesions: Differential Diagnosis and Multimodality Imaging Approach. Radiographics 2022; 42:1514-1531. [PMID: 35839138 DOI: 10.1148/rg.220006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
When a pediatric hepatic cystic lesion is identified at imaging, the differential diagnosis may be broad, including developmental, infectious, neoplastic, and posttraumatic or iatrogenic causes. The location of a cystic lesion and its number, size, composition, and relationship to the biliary system are features that help in narrowing the differential diagnosis. An incidentally detected simple hepatic cyst is the most commonly encountered. Ciliated foregut cysts are typically located in hepatic segment IVa. The presence of multiple cysts should raise suspicion for fibropolycystic liver disease, a group of related lesions-including biliary hamartoma and choledochal cyst-caused by abnormal embryologic development of the ductal plate. Communication of the cystic lesion with the biliary tree can confirm the diagnosis of choledochal cyst. In a neonate with jaundice, a cystic lesion at the porta hepatis should raise suspicion for choledochal cyst versus cystic biliary atresia. Hepatic abscess can appear cystlike, though typically with internal contents. In an immunocompromised child, multiple cystlike lesions should raise concern for fungal microabscesses. A complex cystic mass in a young child should raise suspicion for mesenchymal hamartoma, which can evolve into undifferentiated embryonal sarcoma if untreated. Hepatic hematoma and biloma can appear cystlike in children with a history of trauma or recent intervention. In neonates with an umbilical vein catheter (UVC), an intrahepatic cyst along the course of the UVC should raise concern for infusate extravasation. Familiarity with imaging findings and clinical features is essential for achieving accurate diagnosis of pediatric hepatic cystic lesions, which in turn can guide appropriate clinical management. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Erica L Riedesel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Edward J Richer
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Susan D Taylor
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Ting Tao
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Marie-Helene Gagnon
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Kiery A Braithwaite
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Adina L Alazraki
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Geetika Khanna
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
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10
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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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11
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Shahroor M, Maarouf AM, Yang J, Yankanah R, Shah PS, Mohamed A. Complications Associated with Low Position versus Good Position Umbilical Venous Catheters in Neonates of ≤32 Weeks' Gestation. Am J Perinatol 2022; 39:259-264. [PMID: 32772356 DOI: 10.1055/s-0040-1715117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to determine the incidence of umbilical venous catheter associated infection (UVCAI) in very preterm infants based on UVC tip position. STUDY DESIGN In this retrospective cohort study, infants born at ≤32 weeks were divided into groups with a UVC tip in either a low-lying or good position. The primary outcome was UVCAI. Survival analysis represented time to infection between groups. Subgroup analyses were based on duration of UVC indwelling time. RESULTS Of 1,983 infants, 1,638 infants were eligible; 33% had low-lying UVC and 67% had good position UVC. Survival analyses suggested a significantly higher probability of infection was associated with low UVC (adjusted hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.1-3.2; p = 0.001). The risk of infection was higher for UVC of >7 days duration (adjusted HR: 2.2, 95% CI: 1.1-4.2). Extravasation as a complication was significantly higher in the low UVC versus good position UVC (1.3 vs. 0.1%; odds ratio: 14.4, 95% CI: 1.8-119). CONCLUSION Low-lying UVC was associated with higher risk of infection and extravasation. KEY POINTS · Low-lying UVC are at higher risk of UVCAI.. · Presence of UVC in situ for > 7 days carries higher risk of UVCAI.. · There was a higher risk of UVC extravasation with low UVCs..
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Affiliation(s)
- Maher Shahroor
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ahmad Mustafa Maarouf
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jie Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rosanna Yankanah
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adel Mohamed
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Manea C, Pryce R, Ramadan G. Fifteen-minute consultation: Is this umbilical venous catheter safe to use? Arch Dis Child Educ Pract Ed 2022; 108:173-180. [PMID: 35101937 DOI: 10.1136/archdischild-2019-317388] [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: 11/12/2019] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
Umbilical venous catheters are widely used in neonatal practice, therefore promoting safe use of such catheters to reduce complications remains a healthcare priority. This report will equip the reader with essential knowledge for successful catheter insertion and maintenance, which is key to better outcomes. Recent advances in safe localisation of catheter tip and the development of a red flag system will enhance the clinician's ability to predict potential complications related to these catheters as they remain in situ.
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Affiliation(s)
- Cristina Manea
- Oliver Fisher Neonatal Unit, Medway NHS Foundation Trust, Gillingham, UK
| | - Russell Pryce
- Trevor Mann Baby Unit, Royal Sussex County Hospital, Brighton, UK
| | - Ghada Ramadan
- Oliver Fisher Neonatal Unit, Medway NHS Foundation Trust, Gillingham, UK
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13
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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 2022; 35:89-101. [PMID: 34088575 DOI: 10.1016/j.aucc.2021.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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14
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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: 17] [Impact Index Per Article: 4.3] [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
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15
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Schwaberger B, Schlatzer C, Freidorfer D, Bruckner M, Wolfsberger CH, Mileder LP, Pichler G, Urlesberger B. The Use of a Disposable Umbilical Clamp to Secure an Umbilical Venous Catheter in Neonatal Emergencies—An Experimental Feasibility Study. CHILDREN 2021; 8:children8121093. [PMID: 34943289 PMCID: PMC8699894 DOI: 10.3390/children8121093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
Recent guidelines recommend the umbilical venous catheter (UVC) as the optimal vascular access method during neonatal resuscitation. In emergencies the UVC securement may be challenging and time-consuming. This experimental study was designed to test the feasibility of new concepts for the UVC securement. Umbilical cord remnants were catheterized with peripheral catheters and secured with disposable umbilical clamps. Three different securement techniques were investigated. Secure 1: the disposable umbilical clamp was closed at the level of the inserted catheter. Secure 2: the clamp was closed at the junction of the catheter and plastic wings. Secure 3: the setting of Secure 2 was combined with an umbilical tape. The main outcomes were the feasibility of fluid administration and the maximum force to release the securement. This study shows that inserting peripheral catheters into the umbilical vein and securing them with disposable umbilical clamps is feasible. Rates of lumen obstruction and the effectiveness of the securement were superior with Secure 2 and 3 compared to Secure 1. This new approach may be a rewarding option for umbilical venous catheterization and securement particularly in low-resource settings and for staff with limited experience in neonatal emergencies. However, although promising, these results need to be confirmed in clinical trials before being introduced into clinical practice.
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Affiliation(s)
- Bernhard Schwaberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
- Medizinercorps Graz, Austrian Red Cross Federal Association Styria, 8010 Graz, Austria;
- Correspondence: ; Tel.: +43-316-3853-0018
| | - Christoph Schlatzer
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
| | - Daniel Freidorfer
- Medizinercorps Graz, Austrian Red Cross Federal Association Styria, 8010 Graz, Austria;
| | - Marlies Bruckner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
| | - Christina H. Wolfsberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
| | - Lukas P. Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
| | - Gerhard Pichler
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (C.S.); (M.B.); (C.H.W.); (L.P.M.); (G.P.); (B.U.)
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16
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Patel S, Shannon D, Eldridge W, El-Ters N, Hanford J, Walker T, Scheer A, Jones E, Linwood K, Aragon N, Dunscombe L, Gerbes J, Srinivasan N, Vachharajani A. Understanding umbilical venous catheter insertion practices through a prospective multicenter observational study. J Matern Fetal Neonatal Med 2021; 35:5043-5048. [PMID: 33530795 DOI: 10.1080/14767058.2021.1874908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To understand practices of umbilical venous catheter (UVC) insertion in tertiary level neonatal intensive care units (NICU) and investigate the outcomes of subsequent attempts following a failed initial attempt. STUDY DESIGN Prospective, multi-center observational study of UVC insertions at tertiary level NICUs between March 2019 and January 2020. RESULTS Of the 101 UVCs inserted at 4 centers, seventy-two (71%) were central at the first attempt and 50% were central at subsequent attempts. Patients with at least 1 failed attempt at insertion were less likely to have a centrally placed UVC (p = .009). Manipulations were less likely to be required when UVC was centrally placed during the first attempt. Maneuvers such as posterior liver mobilization used during insertion were likely to be associated with successful central placement of UVC (p = .0243). The time to complete the procedure was significantly less when the UVC was central at the first attempt (34.2 ± 20.2 vs 46.9 ± 33.8) (p = .0292). Gestational age, birth weight, and age of the baby at the insertion of the UVC, experience of the provider, and type of catheter were comparable among groups. The Shukla formula was most commonly used by providers to measure the depth of UVC placement. CONCLUSION Repetitive attempts and manipulations were less likely to be beneficial in the successful central placement of UVC in neonates. Additionally, repetitive attempts at insertion prolonged the overall duration of the procedure.
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Affiliation(s)
- S Patel
- Department of Pediatrics, University of Illinois at Chicago, Oak Park, IL, USA
| | - D Shannon
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - W Eldridge
- Department of Pediatrics, Saint Joseph Women's Hospital, Tampa, FL, USA
| | - N El-Ters
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - J Hanford
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - T Walker
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - A Scheer
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - E Jones
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - K Linwood
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Aragon
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - L Dunscombe
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - J Gerbes
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Srinivasan
- Department of Pediatrics, University of Illinois at Chicago, Oak Park, IL, USA
| | - A Vachharajani
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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17
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Wang J, Yue G, Yang H, Li J, Ju R. Portal venous gas resulting from umbilical vein catheterization in a very-low-birth-weight infant with no interruption in early feeding. Pediatr Investig 2021; 5:155-158. [PMID: 34179714 PMCID: PMC8212711 DOI: 10.1002/ped4.12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Portal venous gas (PVG) is common in necrotizing enterocolitis and occasionally occurs in neonates after umbilical vein catheterization (UVC). Therefore, determining the cause of PVG requires further clinical evaluation in these cases. Case presentation We report the case of a very‐low‐birth‐weight infant who underwent UVC after birth. PVG was an unexpected finding on ultrasound following catheterization. The UVC was immediately removed and replaced with a peripherally inserted central catheter. The infant’s physical examination was unremarkable. Bedside X‐ray revealed neither PVG nor pneumatosis intestinalis, which would indicate the onset of necrotizing enterocolitis. After full evaluation, breastfeeding was started on the same day. The infant did not develop feeding intolerance, necrotizing enterocolitis, or other disorders. Conclusion PVG occasionally occurs in neonates who undergo UVC and is considered to be caused by exogenous gases. PVG is more easily detected with ultrasound than with X‐ray and does not affect early feeding in premature infants.
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Affiliation(s)
- Jun Wang
- Neonatal Department Chengdu Women's and Children's Central Hospital School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Guang Yue
- Neonatal Department Chengdu Women's and Children's Central Hospital School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Hua Yang
- Neonatal Department Chengdu Women's and Children's Central Hospital School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Jing Li
- Neonatal Department Chengdu Women's and Children's Central Hospital School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Rong Ju
- Neonatal Department Chengdu Women's and Children's Central Hospital School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
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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: 33] [Impact Index Per Article: 8.3] [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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Goh SSM, Kan SY, Bharadwaj S, Poon WB. A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore. Singapore Med J 2021; 62:29-33. [PMID: 33619572 PMCID: PMC8027161 DOI: 10.11622/smedj.2019140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Umbilical venous catheters (UVCs), commonly inserted in neonates for vascular access, are not without complications. METHODS A single-centre retrospective cohort study that reviewed complications related to UVC insertion in neonates was conducted in a tertiary neonatal unit in Singapore from January 2016 to July 2017. Ideal UVC position was defined as catheter tip within 0.5 cm above or below the diaphragm. Catheter-related sepsis was defined as clinical or biochemical abnormalities suggesting any new-onset or worsening sepsis 72 hours before or after removal of UVCs, with or without positive culture. Catheter-associated bloodstream infection (CABSI) was defined as positive microbiological growth in one or more blood cultures obtained from a symptomatic infant up to two days after UVC placement or within 48 hours of catheter removal. RESULTS 108 patients had UVC insertions. Mean gestational age and birth weight were 30.4 ± 4.0 weeks and 1,536.2 g ± 788.9 g, respectively. Mean UVC duration was 6.6 days. The UVC was in an ideal position in 27 (25.0%), deep in 13 (12.0%) and short in 35 (32.4%) neonates. One-third of the UVCs (n = 33) were malpositioned. Catheter-related sepsis was observed in 16 (14.8%) neonates, with 5 (4.6%) having CABSI. The most common organism was coagulase-negative Staphylococcus. Other complications include peritoneal extravasation in 3 (2.8%) patients, with two requiring surgical intervention. Venous thrombosis occurred in 2 (1.9%) neonates and was managed conservatively. CONCLUSION Although complication rates were in line with international norms, UVCs were associated with serious complications and should be judiciously used.
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Affiliation(s)
- Sharon Si Min Goh
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Sheau Yun Kan
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Srabani Bharadwaj
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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20
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Born M. The Ductus Venosus. ROFO-FORTSCHR RONTG 2020; 193:521-526. [PMID: 33152783 DOI: 10.1055/a-1275-0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND the ductus venosus (DV) is not well known in general radiology, but it plays a role in the daily work of pediatric radiologists. Consequently all general radiologists who also care for a pediatric department should be familiar with the physiological and pathological findings related to the DV. METHODS Literature research in Medline, using the keywords "ductus venosus" and "umbilical vein catheter". RESULTS AND CONCLUSIONS In the first weeks of life the DV is regularly still patent. It should be recognized as DV and not be mistaken for a pathological portosystemic shunt.The ductus venosus is the lead structure for umbilical vein catheters. Radiologists should be able to assess the correct catheter position. Radiologically important findings of an umbilical vein catheter are mainly malposition and intrahepatic extravasation. Agenesis of the DV can lead to intra- or extrahepatic compensatory portosystemic shunts, in which as well as in the case of persistent patency of the DV, there may be the necessity for radiological-interventional or surgical occlusion. KEY POINTS · In the first weeks of life in infants the Ductus venosus is regularly still patent.. · The Ductus venosus should not be mistaken for a pathological portosystemic shunt.. · An umbilcal vein catheter should project onto the Ductus venosus and end caudal to the right atrium.. · Intrahepatic portosystemic shunts in DV agenesis show a high rate of spontaneous closure postnatally.. CITATION FORMAT · Born M. The Ductus Venosus. Fortschr Röntgenstr 2021; 193: 521 - 526.
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Affiliation(s)
- Markus Born
- Department of Radiology, Division of Pediatric Radiology, University Hospital Bonn, Germany
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Seigel A, Evans N, Lutz T. Use of clinician-performed ultrasound in the assessment of safe umbilical venous catheter tip placement. J Paediatr Child Health 2020; 56:439-443. [PMID: 31654594 DOI: 10.1111/jpc.14658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Amber Seigel
- Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Nick Evans
- Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Tracey Lutz
- Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
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22
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Yeung CY. Complications of umbilical venous catheters in neonates: A safety reappraisal. Pediatr Neonatol 2020; 61:1-2. [PMID: 31953034 DOI: 10.1016/j.pedneo.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, No.92, Sec.2, Chung Shan North Road, 10449, Taipei, Taiwan; School of Medicine, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan.
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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: 2.6] [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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Akar S, Varan C. Evaluation of the distance between the xiphoid process and the umbilicus: Is it appropriate for the measurement of the umbilical venous catheter length? J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Anand V, Pournami F, Panackal AV, Nandakumar A, Prabhakar J, Jain N. Parenteral Nutrition Ascites: Calamity from an Umbilical Vein Cannula. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1720957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractUmbilical vein catheterization is considered a critical requirement in preterm neonates for the administration of fluids and parenteral nutrition. However, inadvertent migration and malposition are known to cause complications that are often life-threatening. We describe a neonate with parenteral nutrition-associated lipid ascites owing to extravasation from an umbilical vein cannula. Fatality was averted due to prompt recognition and paracentesis that was therapeutic and confirmed the diagnosis as well.
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Affiliation(s)
- Vishnu Anand
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Femitha Pournami
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Anila V. Panackal
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Anand Nandakumar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Jyothi Prabhakar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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26
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Young A, Harrison K, Sellwood MW. How to use… Imaging for umbilical venous catheter placement. Arch Dis Child Educ Pract Ed 2019; 104:88-96. [PMID: 30104325 DOI: 10.1136/archdischild-2017-312662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
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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: 1.9] [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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Pegu S, Murthy P. Ascites with hepatic extravasation of total parenteral nutrition (TPN) secondary to umbilical venous catheter (UVC) malposition in an extremely preterm baby. BMJ Case Rep 2018; 2018:bcr-2018-226377. [PMID: 30301731 DOI: 10.1136/bcr-2018-226377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The ease of access and advantages of a secure central line makes use of umbilical venous catheter (UVC) and umbilical artery catheters a part of the standard of care in the extremely premature babies in the neonatal intensive care unit. However, there are complications associated with their use. One of the uncommon complications reported is total parenteral nutrition (TPN) ascites secondary to vessel perforation or hepatic erosion by the tip of the catheter due to malposition of a UVC. We present here a case of such catheter perforation causing ascites and right hepatic collection of TPN in a 28-week-old infant. Abdominal paracentesis was therapeutic by relieving the distension as well as confirming the presence of parenteral nutrition in the peritoneal cavity.
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Affiliation(s)
- Satyaranjan Pegu
- Division of Neonatology, Department of Pediatrics, Regina General Hospital, Regina, Saskatchewan, Canada
| | - Poornima Murthy
- Division of Neonatology, Department of Pediatrics, Regina General Hospital, Regina, Saskatchewan, Canada
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29
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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: 22] [Impact Index Per Article: 3.1] [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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Abstract
OBJECTIVE During neonatal cardiopulmonary resuscitation, early establishment of vascular access is crucial. We aimed to review current evidence regarding different routes for the administration of medications during neonatal resuscitation. DATA SOURCES We reviewed PubMed, EMBASE, and Google Scholar using MeSH terms "catheterization," "umbilical cord," "delivery room," "catecholamine," "resuscitation," "simulation," "newborn," "infant," "intraosseous," "umbilical vein catheter," "access," "intubation," and "endotracheal." STUDY SELECTION Articles in all languages were included. Initially, we aimed to identify only neonatal studies and limited the search to randomized controlled trials. DATA EXTRACTION Due to a lack of available studies, studies in children and adults, as well as animal studies and also nonrandomized studies were included. DATA SYNTHESIS No randomized controlled trials comparing intraosseous access versus peripheral intravascular access versus umbilical venous catheter versus endotracheal tube versus laryngeal mask airway or any combination of these during neonatal resuscitation in the delivery room were identified. Endotracheal tube: endotracheal tube epinephrine administration should be limited to situations were no vascular access can be established. Laryngeal mask airway: animal studies suggest that a higher dose of epinephrine for endotracheal tube and laryngeal mask airway is required compared with IV administration, potentially increasing side effects. Umbilical venous catheter: European resuscitation guidelines propose the placement of a centrally positioned umbilical venous catheter during neonatal cardiopulmonary resuscitation; intraosseous access: case series reported successful and quick intraosseous access placement in newborn infants. Peripheral intravascular access: median time for peripheral intravascular access insertion was 4-5 minutes in previous studies. CONCLUSIONS Based on animal studies, endotracheal tube administration of medications requires a higher dose than that by peripheral intravascular access or umbilical venous catheter. Epinephrine via laryngeal mask airway is feasible as a noninvasive alternative approach for drug delivery. Intraosseous access should be considered in situations with difficulty in establishing other access. Randomized controlled clinical trials in neonates are required to compare all access possibilities described above.
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31
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Gordon A, Greenhalgh M, McGuire W, Cochrane Neonatal Group. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Cochrane Database Syst Rev 2017; 10:CD012142. [PMID: 29017005 PMCID: PMC6485860 DOI: 10.1002/14651858.cd012142.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lengthy duration of use may be a risk factor for umbilical venous catheter-associated bloodstream infection in newborn infants. Early planned removal of umbilical venous catheters (UVCs) is recommended to reduce the incidence of infection and associated morbidity and mortality. OBJECTIVES To compare the effectiveness of early planned removal of UVCs (up to two weeks after insertion) versus an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants.To perform subgroup analyses by gestational age at birth and prespecified planned duration of UVC placement (see "Subgroup analysis and investigation of heterogeneity"). SEARCH METHODS We used the standard Cochrane Neonatal search strategy including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), Ovid MEDLINE, Embase, and the Maternity & Infant Care Database (until May 2017), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared effects of early planned removal of UVCs (up to two weeks after insertion) versus an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently undertook data extraction. We analysed treatment effects and reported risk ratio (RR) and risk difference (RD) for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We planned to use a fixed-effect model in meta-analyses and to explore potential causes of heterogeneity in sensitivity analyses. We assessed the quality of evidence for the main comparison at the outcome level using GRADE methods. MAIN RESULTS We found one eligible trial. Participants were 210 newborn infants with birth weight less than 1251 grams. The trial was unblinded but otherwise of good methodological quality. This trial compared removal of an umbilical venous catheter within 10 days after insertion (and replacement with a peripheral cannula or a percutaneously inserted central catheter as required) versus expectant management (UVC in place up to 28 days). More infants in the early planned removal group than in the expectant management group (83 vs 33) required percutaneous insertion of a central catheter (PICC). Trial results showed no difference in the incidence of catheter-related bloodstream infection (RR 0.65, 95% CI 0.35 to 1.22), in hospital mortality (RR 1.12, 95% CI 0.42 to 2.98), in catheter-associated thrombus necessitating removal (RR 0.33, 95% confidence interval 0.01 to 7.94), or in other morbidity. GRADE assessment indicated that the quality of evidence was "low" at outcome level principally as the result of imprecision and risk of surveillance bias due to lack of blinding in the included trial. AUTHORS' CONCLUSIONS Currently available trial data are insufficient to show whether early planned removal of umbilical venous catheters reduces risk of infection, mortality, or other morbidity in newborn infants. A large, simple, and pragmatic randomised controlled trial is needed to resolve this ongoing uncertainty.
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Affiliation(s)
- Adrienne Gordon
- Royal Prince Alfred HospitalNeonatologyMissenden RoadCamperdownSydneyNSWAustralia2050
| | - Mark Greenhalgh
- RPA Women and Babies, Royal Prince Alfred HospitalRPA Newborn CareSydneyNSWAustralia2050
| | - William McGuire
- Centre for Reviews and Dissemination, The University of YorkYorkY010 5DDUK
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Kurtom W, Quast D, Worley L, Oelberg DG. Incorrect umbilical vein catheterization is associated with severe periventricular hemorrhages and mortality in extremely premature newborns. J Neonatal Perinatal Med 2017; 9:67-72. [PMID: 27002266 DOI: 10.3233/npm-16915060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the relationship between umbilical vein catheter (UVC) placement and death in extremely premature newborns (<29 weeks gestation). STUDY DESIGN Utilizing a retrospective, case-control study design, results for newborns that received UVC placements and died were compared with those who received UVC placements and survived (n = 719) by univariate and multiple logistic regression analyses. RESULT Death rate was 30% in infants with low lines versus 16% in those without (p = 0.012). High UVC tip placement significantly and independently increased severe periventricular hemorrhages (p = 0.014). Severe periventricular hemorrhage increased death rates by 3-fold independent of gestational age (p < 0.001). Proper line placement significantly reduced severe periventricular hemorrhage by 2.5-fold independent of gestational age (p = 0.019). CONCLUSION In extremely premature newborns, incorrect UVC placement is significantly associated with death through its relation to severe periventricular hemorrhage.
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Affiliation(s)
- Waleed Kurtom
- Children's Hospital of The King's Daughters, Norfolk, VA, USA.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Deborah Quast
- Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - Leslie Worley
- Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - David G Oelberg
- Children's Hospital of The King's Daughters, Norfolk, VA, USA.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
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Franta J, Harabor A, Soraisham AS. Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study. Arch Dis Child Fetal Neonatal Ed 2017; 102:F251-F255. [PMID: 28424358 DOI: 10.1136/archdischild-2016-311202] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/17/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the umbilical venous catheter (UVC) tip position by ultrasound and compare it with standard radiograph findings and to examine the catheter tip migration rates during the first week of life. DESIGN Prospective observational study of inborn preterm infants who had an UVC placed and its position radiographically confirmed. The first ultrasound was done on UVC placement at median (IQR) age of 2 hours (1-4) and follow-up scans at a median (IQR) age of 34 hours (27-44 hours), 77 hours (70-94 hours) and 6 days (5-7 days) after insertion. Catheter tip was considered in optimum position if tip was lying in the inferior vena cava up to the right atrium opening. RESULTS We studied 65 infants at a mean (±SD) gestational age and birth weight of 26.4 (±2.1) weeks and 808 (±289) g, respectively. Ultrasound confirmed optimum position of UVC tip in 25/65 (38.5%) infants. Majority (38/40) of the malpositioned catheters were located inside the heart with 15 reaching the left atrium. Catheter tip migration occurred in 29 of 58 infants (50%) at any time during the first week. The proportions of UVC migration were found to be 17%, 31% and 29% on subsequent ultrasound with a trend to outward movement over time. CONCLUSION UVC tip localisation by standard radiography is very imprecise, and catheter tip migration occurs in a significant proportion of infants during first weeks of age. We suggest ultrasound as the best modality to assist localisation and follow-up of UVC tip in preterm infants.
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Affiliation(s)
- Jan Franta
- National Neonatal Transport Programme, National Maternity Hospital, Coombe Women & Infants University Hospital, Rotunda Hospital, Dublin, Ireland
| | - Andrei Harabor
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Amuchou S Soraisham
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Epelman M, Johnson C, Hellinger JC, Darge K, Newman B. Vascular Lesions—Congenital, Acquired, and Iatrogenic: Imaging in the Neonate. Semin Ultrasound CT MR 2015; 36:193-215. [DOI: 10.1053/j.sult.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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