Umbilical Catheter Research Articles

Hepatic Lesions of Total Parenteral Nutrition (Tpn) Secondary to Umbilical Venous Catheter (Uvc) Malposition in A Very Low-Birth Weight Infant in China

Umbilical vein catheterization (UVC) is a common operation for vascular access in preterm infants. However, there are complications associated with their use. We here a case of extravasation of the fluids due to misplacement of the catheter causing hepatic collection of TPN in a very low-birth weight preterm (VLBW) infant.

Hepatic Lesions of Total Parenteral Nutrition (Tpn) Secondary to Umbilical Venous Catheter (Uvc) Malposition in A Very Low-Birth Weight Infant in China

Umbilical vein catheterization (UVC) is a common operation for vascular access in preterm infants. However, there are complications associated with their use. We here a case of extravasation of the fluids due to misplacement of the catheter causing hepatic collection of TPN in a very low-birth weight preterm (VLBW) infant.

Ultrasound Monitoring of Umbilical Catheters in the Neonatal Intensive Care Unit-A Prospective Observational Study.

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.

Factors Associated with Umbilical Venous Catheter Malposition in Newborns: A Tertiary Center Experience.

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. 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. 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. 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. · 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..

Off label use of PICC as umbilical arterial catheter: Clinical case series.

Umbilical arterial catheters are often placed at birth in critical ill neonates. Advantages of umbilical arterial catheterization include continuous blood pressure monitoring, accurate blood gas and frequent blood samplings. We described the off-label use of a third generation polyurethane power injectable 3 Fr single lumen peripheral inserted central catheter as umbilical arterial catheter. This clinical case series opens new scenarios about the off-label use of power PICC in newborns. Prospective studies are needed to evaluate the safety and advantages of PICCs as umbilical catheters over the conventional old generation polyurethane neonatal catheters.

EFEKTIFITAS PERAWATAN INFUS UMBILIKAL TERHADAP TIMBULNYA FLEBITIS PADA NEONATUS

<strong>Background </strong>: The things to do to prevent from the appearance of phlebitis are the changing of the wound covering sterilized dressing, the evaluation to the appearance of phlebitis, the changing of the insertion area at every 48-72 hours, and the use of new catheterization set. The neonatus catheterization is usually placed at umbilical vein. As a result the neonatus with umbilical catheterization is easy to get phlebitis if the catheterization isn’t appropriate. <strong>Objective </strong>: To understand the difference of the effectiveness of the umbilical intravenous catheterization nursing using dry sterilized dressing and covered antiseptic sterilized dressing concerned with the appearance of phlebitis on neonatus. <strong>Method : </strong>The study was a queasy-experiment with post-test only design; used to examine the difference of effectiveness of the umbilical intravenous catheterization nursing using dry sterilized dressing and covered antiseptic sterilized dressing concerned with the appearance of phlebitis on neonatus. <strong>Result </strong>: The result showed that there was no significant differences in the use of the dry sterilized dressing nursing and the covered antiseptic sterilized one as shown by p value score as much as 0,663 >0,05 with the fact that the Low Birth-weight babies and premature ones tend to have phlebitis. <strong>Conclusion : </strong>There is no significant differences<strong> </strong>in the umbilical catheterization nursing between use of the dry sterilized dressing and the covered antiseptic sterilized one concerned with the appearance of phlebitis but there is a tendency that the low birth-weight neonatus and premature ones will have phlebitis more easily.

Neonato pretermine con lesione epatica

Umbilical venous catheterization (UVC) is a common procedure performed in neonatal intensive care units. Inadvertent extravasation of parenteral nutrition (PN) into the liver parenchyma causing a fluid collection defined as TPN-oma is a well-known complication due to malpositioned UVC. The paper reports the case of a preterm female infant born at 30 weeks gestational age with a hepatic lesion containing PN fluid, successfully treated with ultrasound-guided aspiration.

Incidence and risk factors of central line catheter-related bloodstream infections.

Central line catheter-related bloodstream infections (CLABSI) burdens great morbidity, mortality and unnecessary hospital expenses. Studies related to its incidence and epidemiological and clinical profile among neonates in Peru are scarce, not being clear it's actual impact. A prospective cohort study was conducted in a neonatal intensive care unit (ICU) of a public hospital in Lima, Peru between 2017-2018. 167 patients were included (52,7% male) with gestational age between 24-41 weeks, obtaining 1999 catheter-days and 16 cases of CLABSI. The incidence rate was 8/1000 catheter-days. Use of umbilical catheter (p=0,005) and multiple catheters (p<0,001) both showed a statistically significant correlation regarding the development of CLABSI. It's necessary to extend the study to other ICUs and stablish solid, efficient and long-lasting system of CLABSI surveillance that allows the evaluation of possible interventions to reduce the incidence of CLABSI.

Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study

BackgroundRecent guidelines advocate the use of real-time ultrasound to locate umbilical venous catheter tip. So far, training programs are not well established.MethodsA pre/post interventional study was carried out in our tertiary neonatal intensive care unit centre to evaluate the efficacy of a training protocol in the use of real-time ultrasound. Primary outcome was the percentage in the use of real-time ultrasound.ResultsFifty-four patients were enrolled. The use of real-time ultrasound for tip location significantly increased after the training program (15.3% vs 89.2%, p < 0.0001). After the training the tip of the catheters was more frequently placed at the junction of the inferior vena cava and right atrium (75% vs 30.7%, p = 0.0023). Twenty-two catheters were also evaluated with serial scans during the intervention phase to assess migration rate which was 50%.Conclusiona multimodal, targeted training on the use of real-time ultrasound for umbilical venous catheter placement is feasible. Real-time ultrasound is easily teachable, increases the number of umbilical venous catheters placed in a correct position, reduces the number of line manipulations and the need of chest-x-rays.

Enteral Nutrition in Term Infants with Congenital Heart Disease: Knowledge Gaps and Future Directions to Improve Clinical Practice.

Optimal nutrition is essential to improve short- and long-term outcomes in newborns with congenital heart disease (CHD). Nevertheless, several issues on nutritional management and concerns about the potential risk of complications related to enteral feeding exist. This narrative review aims to summarize and discuss the available literature on enteral feeding in term infants with CHD. A wide variability in feeding management exists worldwide. Emerging approaches to improve nutritional status and outcomes in infants with CHD include: implementation of a standardized enteral feeding protocol, both preoperative and postoperative, clearly defining time of initiation and advancement of enteral feeds, reasons to withhold, and definitions of feeding intolerance; early minimal enteral feeding; enteral feeding in stable term infants on hemodynamic support; evaluation of enteral feeding in term infants with umbilical arterial catheters and during prostaglandin infusion; assessment and support of oro-motor skills; and promotion and support of breastfeeding and provision of mother’s own milk or donor milk when mother’s own milk is not available. As evidence from term infants is scarce, available observations and recommendations partially rely on studies in preterm infants. Thus, well-designed studies assessing standardized clinically relevant outcomes are needed to provide robust evidence and shared recommendations and practices.

Randomised trial of epinephrine dose and flush volume in term newborn lambs

ObjectivesNeonatal resuscitation guidelines recommend 0.5–1 mL saline flush following 0.01–0.03 mg/kg of epinephrine via low umbilical venous catheter for persistent bradycardia despite effective positive pressure ventilation (PPV) and chest compressions...

Umbilical Cord Separation Time and Influencing Factors in Very-Low-Birth-Weight Preterm Neonates.

The average time for umbilical cord separation in term neonates is 7 to 10 days. Prematurity, phototherapy, prolonged duration of antibiotic treatment, and parenteral nutrition are other factors which were demonstrated to delay cord separation. In the previous studies including greater premature infants, the time of separation of the umbilical cord was shown to vary 2 to 3 weeks. We aimed to determine the cord separation time and associated factors in very-low-birth-weight (VLBW) infants. In this retrospective study, VLBW infants (birth weight [BW] <1,500 g, gestational age [GA] < 32 weeks) without umbilical catheterization were included. Specific cord care was not applied. The cord separation time, gender, mode of delivery, presence of sepsis, duration of antibiotic treatment, serum free thyroxine, free triiodothyronine (FT3), thyroid-stimulating hormone, lowest leukocyte, polymorphonuclear leukocytes (PMNLs), and platelet counts were recorded. The study included 130 infants (GA: 29 ± 2 weeks, BW: 1,196 ± 243 g). Mean cord separation time was 14 ± 5 days, while 95th percentile was 22nd day of life. A positive correlation was demonstrated between duration of antibiotic treatment and cord separation time (p < 0.001, r: 0.505). Cord separation time did not differ regarding gender or mode of delivery. Corrected leukocyte count (p = 0.031, r: -0.190) and PMNL count (p = 0.022, r: -0.201), and serum FT3 level (p = 0.003, r: -0.261) were found to be negatively correlated with cord separation time. The cord separation time was found to be delayed in the presence of sepsis (with sepsis: 18 ± 7 days and without sepsis: 13 ± 3 days; p = 0.008). Sepsis was found to delay the cord separation time beyond second week (odds ratio = 6.30 [95% confidence interval: 2.37-15.62], p < 0.001). The 95th percentile for cord separation time was 22nd day. Sepsis might be either the reason or the consequence of delayed cord detachment. The exact contribution of low serum FT3 levels to the process of cord separation should be investigated in further studies. · Mean cord separation time was 14 ± 5 days, while 95th percentile was 22nd day, in VLBW infants.. · Sepsis was found to delay the cord separation time by sixfold beyond second week.. · Serum free triiodothyronine level was negatively correlated with cord separation time..

Risk Factors for Central Venous Line Complications Versus Umbilical Veous Catheter in Premature Neonates Admitted to El Warak Centeral Hospital Neonatal Intesive Care Unit

peripherally inserted central catheters (PICCs) are routinely used in term and preterm infants to provide intravenous access for prolonged therapy and parenteral nutrition. They are known to reduce the complications associated with the conventionally used central catheters. PICCs can be conveniently inserted at the bedside without the need for surgical intervention. The point of the available investigation might have been with assess those danger figures to vital venous offering difficulties versus umber venous catheter over preterm neonates admitted to el Warak national clinic in neonatal seriousness Furthermore its result. This Prospective observational consider required been conveyed out in NICUs toward el Warak national clinic between December2018 Also december 2019, those ponder might have been conveyed out ahead 100 newborns ( preterm) that were admitted will nicu by diverse result in Also have focal embedded vascular catheter (Umbilical venous catheter Also vital veous cathter). Comes about of the study uncovered that crp Also PTT were altogether higher in CVC one assembly contrasted with UVC. However, TLC, platelets check Also HCT qualities were more level same time inr might have been higher On CVC gathering contrasted with UVC bunch without measurable hugeness distinction Also direct might have been the The greater part incessant condition around the two groups, In awful condition might have been All the more incessant over CVC assembly. However, there may be no huge Contrast the middle of the Assemblies in regards general condition. There might have been no noteworthy distinction in the occurrence about CABSI the middle of altogether preterm neonates who accepted a CVC alternately UVC Concerning illustration those elementary mode about venous get after conception. A prospective randomized regulated trial will be advocated will further aide act viewing essential venous get What's more diminishment from claiming spoiling.

Abnormal Ocular Examination Findings in a Term Infant.

A 3-hour-old full-term female neonate presents with white pupils noted at the time of NICU admission. ### Prenatal and Birth Histories The infant was limp and cyanotic at delivery and required positive pressure ventilation for 5 minutes. No risk factors for sepsis were noted and there was no evidence of placental abruption. In addition, the fetal heart rate tracing was normal before delivery. The reasons for the perinatal depression at birth were unclear. Subsequently, the infant started breathing spontaneously and was transitioned to room air. Neurologic examination findings obtained at the outside facility were significant for wide-eyed appearance with staring and generalized low muscle tone. ### Presentation The infant was transferred to the NICU at 3 hours of age for therapeutic hypothermia evaluation. Initial physical examination findings were remarkable for the presence of leukocoria bilaterally. This was visualized easily with both ambient lighting in the patient room as well as direct examination with an ophthalmoscope (Fig 1). Red reflex was absent bilaterally. Figure 1. Bilateral leukocoria. The infant’s neurologic assessment findings at admission were consistent with moderate hypoxic-ischemic encephalopathy. Therapeutic whole-body cooling was initiated. An umbilical venous catheter was placed and continuous electroencephalogram obtained. The infant also received ampicillin and ceftazidime, intravenous fluids, and continuous fentanyl infusion. ### Vital Signs (3 Hours of Age)

Catheter-Related Ascites in a Preterm Infant

We are reporting a case of neonatal ascites secondary to misplacement of umbilical venous catheter. The case is supported by the literature review.

Imaging appearance of post umbilical venous catheter displacement: liver collections in children.

Umbilical venous catheters (UVCs) have become a part of routine perinatal care. In the case of its misplacement, extravasation into liver parenchyma might be observed and unusual findings might be detected and a suspicion of tumoral lesions emerges during the ultrasound examination. To avoid the unnecessary liver biopsies and catastrophic complications of UVC misplacement in the pediatric population, clinicians and radiologists must be familiar with the radiological findings. We aimed to present sonographic and computed tomographic images of liver collections resulting from UVC malposition.

The Development of a Simulated Umbilical Line Insertion Model and Curriculum in the Neonatal Intensive Care Unit.

BackgroundInsertion of an umbilical venous catheter (UVC) is a required skill for pediatric residents to learn and perform effectively. However, there is known variability in the ability of residents to perform this essential neonatal skill.ObjectiveThe objective of our study was to create a competency-based curriculum for umbilical vein catheter insertion using a human umbilical tissue simulated model, and to assess the feasibility of the curriculum on resident learners during their neonatology rotations.MethodsWe evaluated the curriculum by assessment of resident learning, reactions, and behaviours. Performance was assessed using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE).ResultsA total of 14 residents were included for analysis. The majority were ‘senior’ residents (postgraduate year (PGY)-3 and PGY-4 n = 10; PGY-1 n =4), and they reported a wide range of previous experience with UVC insertion prior to this curriculum implementation. The residents’ reaction to the curriculum was overwhelmingly positive. All residents maintained or improved in their knowledge assessment. O-SCORE results showed improvement in UVC insertion before and after curriculum completion for both junior (2.5 +/- 0.71 to 4.5 +/- 0.41) and senior (3.55 +/- 0.42 to 4.95 +/- 0.15, p < 0.001) residents. The mean improvement in O-SCORE was greater for junior residents than senior residents.ConclusionThe results of this study demonstrate the feasibility and emerging impact of a competency-based curriculum using simulation for procedural skills.

Understanding umbilical venous catheter insertion practices through a prospective multicenter observational study

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.

Placental gas exchange during amniotic carbon dioxide insufflation in sheep.

Insufflation of the amniotic cavity with carbon dioxide (CO2 ) is used clinically to improve visibility during complex fetoscopic surgery. Insufflation with heated, humidified CO2 has recently been shown to reduce fetal hypercapnia and acidosis in sheep, compared with use of cold and dry CO2 , but the underlying mechanisms are unclear. The aim of this study was to investigate whether differences in placental CO2 and oxygen (O2 ) exchange during insufflation with heated and humidified vs cold and dry CO2 could explain these findings. Thirteen fetal lambs at 105 days of gestation (term, 146 days) were exteriorized partially, via a midline laparotomy and hysterotomy, and instrumented with an umbilical artery catheter, an umbilical vein catheter and a common umbilical vein flow probe. Arterial and venous catheters and flow probes were also inserted into the maternal uterine circulation. Six ewes were insufflated with cold, dry CO2 (22°C; 0-5% humidity) and seven with heated, humidified CO2 (40°C; 95-100% humidity) at 15 mmHg for 180 min. Blood-flow recordings and paired arterial and venous blood gases were sampled from uterine and umbilical vessels. Rates of placental CO2 and O2 exchange were calculated. After 180 min of insufflation, fetal survival was 33% (2/6) using cold, dry CO2 and 71% (5/7) using heated, humidified CO2 . By 120 min, fetuses insufflated with heated, humidified CO2 had lower arterial CO2 levels and higher arterial pH compared to those insufflated with cold, dry gas. Insufflation decreased significantly placental gas exchange in both groups, as measured by rates of both (i) fetal CO2 clearance and O2 uptake and (ii) maternal O2 delivery and CO2 uptake from the fetal compartment. Lower arterial CO2 and higher pH levels in fetuses insufflated with heated and humidified, compared to cold and dry, CO2 could not be explained by differences in placental gas exchange. Instead, heated and humidified insufflation appeared to reduce fetal CO2 absorption from the uterus, supporting its use in preference to cold, dry CO2 . © 2019 International Society of Ultrasound in Obstetrics and Gynecology.

The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study

Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p=0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p=0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p=0.005). Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.