Role of bedside ultrasound in determining the position of umbilical venous catheters

Abstract

Background: Umbilical venous catheter (UVC) is the most commonly used central venous line during neonatal resuscitation. Misplacement is responsible for potential serious complications. Aims: The aim was to find out the ability of bedside ultrasound to determine the UVC tip position (TP). Ultrasound may then be the new gold standard saving unnecessary radiographs thus decreasing the radiation dose received by neonates. Early detection of UVC misplacement will help in preventing complications as ultrasound is easy, readily available at the bedside. Settings and Design: Prospective blind comparison to a gold standard. Subjects and Methods: Our study included all neonates admitted to the neonatal intensive care unit from February 2013 to October 2013 who required insertion of UVC. Exclusion criteria included neonates with thoracic or abdominal congenital abnormalities, critically ill or very low birth neonates and withdrawal of parent consent. A portable chest-abdomen radiograph was obtained followed by bedside ultrasound examination by a senior radiologist blinded to the radiograph interpretation. The UVC TP determined by ultrasound was compared to chest-abdomen radiograph interpretation. Statistical Analysis: Sensitivity, specificity, accuracy positive and negative predictive values for ultrasound results were calculated. Results: Seventy-five catheter insertions for 74 neonates were included in our study. The sensitivity, specificity, and accuracy of ultrasound were 91.3%, 94.2%, and 93.3%, respectively, with a positive predictive value of 87.5% and a negative predictive value of 96.1%. Conclusion: Our results show that bedside ultrasound could replace thoracoabdominal radiograph in determining UVC TP therefore decreasing neonatal radiation dose and decreasing or preventing complications resulting from misplacement.