38 Does Umbilical Venous Catheter tip position impact complication rates in neonates?

Abstract

Abstract Background Umbilical venous catheter (UVC) insertion is a very common procedure in neonatal intensive care units (NICU). UVCs are placed in ideal position in only about 50% cases. It is common practice to secure UVC in low position in the event of failure to place in optimal position. However, little is known about the association between catheter tip position and UVC related complications in neonates. Objectives The primary objective was to examine the association between the UVC tip position and UVC related complications in neonates. Our secondary objective was to evaluate the association between timing of UVC insertion and complication rates. Design/Methods We performed a retrospective cohort study of all neonates who had UVC inserted in a tertiary NICU between January 2017 and December 2018. Neonates with major congenital or chromosomal anomalies, hydrops fetalis and prenatally diagnosed cardiac arrhythmias or pericardial effusion were excluded. Electronic medical records and medical charts were reviewed. The primary outcome was presence of any one of the following complications: cardiac (arrhythmias, pericardial effusion, intracardiac thrombosis), hepatic (liver hematoma, cystic fluid collection in the liver, liver abscess, portal vein thrombosis), catheter associated infection, and mechanical complications. We compared the complications rates based on UVC tip position as determined by thoraco-abdominal radiograph. Optimal UVC position was defined as catheter tip between T8-T10 vertebral levels; low position as below T10 and high position as above T8. We also examined the association between time at UVC insertion (i.e. early (<12 hours) versus late (≥12 hours) and the type of complications. Results Among the 589 neonates who had UVC inserted during the study period, 40 were excluded. Of 549 included, UVC tip was at optimal position in 267 (48.6%), low position in 248 (45.2%) and high position in 34 (6.2%) neonates. The mean gestational age and birth weight of the study cohort were 30.9 ± 5.1 weeks and 1712 ± 1035g respectively. The mean birth weight and gestational age were comparable among the three groups. The overall complication rate was 36/549 (6.5%). There were no significant differences in the overall complication rates between the three groups (Table 1). However, cardiac complications (arrhythmias) were more frequent in the high UVC group compared to the optimum position group (8.8% vs 0.37%, OR 10; 95% CI 1.84, 56.5). Among 549 neonates, 391 had early UVC insertion and 158 had late insertion of UVC. There was no significant difference in UVC related complications between early and late insertion of UVC (6.9 % versus 5.7%, OR 2.49; 95% CI 0.34, 17.8). Conclusion The UVC related complications were more frequent in infants with high UVC position and least among those with optimal UVC position; although not statistically significant, it may be clinically important. High UVC position was more frequently associated with cardiac complications. There was no difference in complication rates between early and late UVC insertion.