Abstract
Introduction: Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. The aim of our study was to determine whether the repeated ultrasound scanning can influence the catheterization time, prevent some of the catheter-related complications, support the decision-making process and allow prolonged catheterization in patients without an alternative central access route.Methods: A prospective observational study was performed in a tertiary neonatal intensive care unit. A total of 129 patients and 194 umbilical catheters (119 venous and 75 arterial) were analyzed with a total of 954 scans. Ultrasound screening consisted of 1) assessing the catheter tip, location, movability, and surface and 2) analyzing the catheter trajectory. The outcome variables were defined as 1) catheter dislocation and 2) associated thrombosis.Results: Dislocation of catheter throughout the whole catheterization period was observed in 68% (81/119) of UVCs and 23% (17/75) of UACs. Thrombotic complications were observed in 34.5% (41/119) of UVCs and 12% (9/75) of UACs. 1/3 of UAC-associated thrombi were visible only after catheter removal. 51% (61/119) of UVC patients and 8% (6/75) of UAC patients made a clinical decision regarding the obtained catheter image.Conclusion: Bedside ultrasound imaging of catheters supports the decision-making process related to the catheterization duration, shortening the time if abnormalities are detected and allowing a safer prolonged UC stay when an alternative central line cannot be inserted.
Highlights
Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else
Since 1946 [1], when umbilical catheterization was first applied for exchange transfusion by Diamond [2], chest radiography has been the technique of choice for assessing the position of a catheter; due to radiation concerns, it is usually performed only once after catheter insertion
A prospective observational study was conducted in a tertiary neonatal intensive care unit (NICU) in the Department of Pediatrics, Jagiellonian University between February 1, 2016 and April 30, 2019
Summary
Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. Umbilical catheters (UCs) are a unique form of central arterial and venous access that can be applied only within the first hours of life. They enable an easy, quick, and painless catheterization route, sparing the other main vessels of the smallest patients for the future. Neonatal point-of-care ultrasound plays a growing role in intensive care—lately a Working Group of the European Society of Pediatric and Neonatal Intensive Care provided an evidence-based clinical guideline for the use of point-of care ultrasound in critically ill neonates and children (February 2020) [3] recommending its use by clinicians; the role of umbilical catheter monitoring remains unclear
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