Umbilical Catheter Research Articles

Predictors of Umbilical Venous Catheter Misalignment.

Introduction: The insertion of an umbilical venous catheter (UVC) is a routine procedure. The success rate of this procedure is about 40–50%, with potential complications arising from misaligned UVC placement. Objectives: To explore potential factors that may aid in the prediction of UVC misalignment. We hypothesized that UVC misalignment is proportionally related with increased chronological age. Methods: Retrospective chart review for newborns who had an UVC procedure followed by an x-ray. All analyses were conducted using standard comparative statistical methods and logistic regression modelling with SPSS v.24 (IBM Corp., Armonk, NY, USA), and p-values < 0.05 were considered statistically significant. Results: The final sample size was 480 patients. There were significant differences between the two groups in terms of gestational age {OR 1.06, 95% CI (1.02–1.10)}, small for gestation (SGA) status {OR 1.07, 95% CI (0.98–1.15)}, and 5-min APGAR scores {OR 0.48, 95% CI (0.23–1.00)}. There were no other significant group differences. Logistic regression modeling identified that chronologic age positively predicted, and SGA negatively predicted, UVC misalignment. Conclusion: A misaligned UVC is more likely to occur in late preterm and term babies, whereas a baby being SGA increases the likelihood of a well-aligned UVC.

Position of the umbilical venous catheter in neonatal resuscitation

The article summarizes many years of experience with radiographs in the neonatal intensive care unit (ICU), provides criteria for the correct and acceptable position of the umbilical venous catheter (UVC). Of the 180 cases observed by the authors, images of 16 clinical cases with incorrectly set UVC, were selected and presented in the article. All radiographs shown are classified depending on the depth of insertion and inadmissible location of the catheter; rationale and interpretation of images are given, with an explanation of possible complications in each case. Based on the above material, the need for "input control" upon admission of a newborn from the maternity ward (transfer to a specialized hospital) was proved in order to prevent the development of complications: pulmonary embolism, iatrogeny

Liver abscesses in the Western pediatric population.

Liver abscesses are rare in the Western pediatric population and data on predisposing factors and etiology are scarce. We aimed to describe predisposing factors, microbiological characteristics, and treatment. Retrospective analysis of children admitted to two tertiary care hospitals in Belgium from 1 January 1996 to 31 December 2019. We analyzed clinical features, predisposing factors, imaging characteristics, microbiological data, treatment, and outcome in children with a liver abscess and compared these data with the literature. We collected 24 cases with a male to female ratio of 1.4 and a median age of 3.2 years at time of diagnosis. Survival was 95.8%. Invasive culture specimens were obtained in 83.3% and showed growth of bacteria in 55%. Parenteral antibiotics were administered before invasive culture sampling in 80%. Liver abscesses were cryptogenic in four (16.7%) patients. Hepatobiliary disease was the most prevalent predisposing factor (n = 6; 25%), followed by recent antineoplastic therapy for malignancies (n = 5; 20.8%), intra-abdominal surgical pathology (n = 4; 16.7%) and umbilical venous catheters (n = 2; 8.3%). In two patients there was a parasitic origin (n = 2; 8.3%) and in one it was caused by Bartonellosis. There was no diagnosis of chronic granulomatous disease (CGD) in our cohort. Pediatric liver abscesses have a favorable outcome in the developed world. Whenever feasible, invasive abscess culture specimens should be obtained. In patients presenting with a cryptogenic liver abscess or atypical disease course, immunological workup should be ensured.

Enterocolitis and congenital heart disease

Congenital heart disease (CHD) represents a risk factor for necrotizing enterocolitis (NEC). To describe and compare the characteristics of infants with CHD who present either a NEC or an isolated digestive symptom. This retrospective single-center study included 67 infants with CHD under 3 months of age who presented with NEC ( n = 36, NEC group) or an isolated digestive symptom ( n = 31, No-NEC group) between January 2016 and December 2020 in the pediatric cardiology unit of the Lyon university hospital (France). CHD types were mainly coarctation of the aorta, pulmonary atresia, and transposition of the great arteries. Prostaglandin infusion was administered to 67.2% of infants, 73.1% had an umbilical venous catheter, 67.2% underwent cardiac surgery, 38.8% had a percutaneous interventional catheterization, and 11.9% had no intervention. NEC tended to be more frequent in infants who underwent palliative surgery or a prolonged discontinuation of prostaglandins compared to those who had a complete surgical repair. The cardiac intervention was performed later in the NEC group. Digestive events occurred more frequently before the cardiac intervention but in that case NEC was not more frequent although all the infants were fed. Mother's own milk was less frequently used in the NEC group, and the proportion of hypotrophic newborns and the use of fortified formula and antibiotics was higher in the NEC group. Cardiac procedure should not be delayed in order to prevent preoperative NEC. Careful feeding does not increase the incidence of NEC and the administration of mother's own milk or donor human milk should be promoted in this population.

Hepatic laceration and total parenteral nutrition extravasation due to dislocation of an umbilical venous catheter.

Hepatic laceration and total parenteral nutrition extravasation due to dislocation of an umbilical venous catheter.

Neonatal Atrial Flutter: Clinical Characteristics of 14 Cases in a Single Center

Purpose: Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates.Methods: The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively.Results: All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge.Conclusion: Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.

Loss of Leg Secondary to an Umbilical Arterial Catheter

Loss of Leg Secondary to an Umbilical Arterial Catheter

Ultrasound-Guided Umbilical Venous Catheter Insertion to Reduce Rate of Catheter Tip Malposition in Neonates: A Randomized, Controlled Trial.

To investigate whether ultrasound-guided umbilical venous catheter (UVC) insertion (US group) reduced the rate of malpositioning of the catheter tip compared to the standard method of insertion (SD group). In this open-label, randomized, controlled trial, neonates admitted to NICU within the first week of life were randomly assigned to the US group (n = 26) or SD group (n = 27). Neonates with major congenital anomalies of the thorax and abdomen were excluded. The primary outcome was the rate of malpositioning of the catheter tip. The rate of malpositioning of the catheter tip was observed in a significantly lower number of neonates in the US group as compared to the SD group (11/26, 42.3% vs. 20/27, 74%; RR = 0.57, 95% CI: 0.34 to 0.94, p = 0.019). As more of the UVCs were positioned optimally in the first attempt in the US group than SD group, the need for repeated attempts at catheter repositioning was reduced, resulting in reduced procedure time (minutes) [mean (SD), 23.96 (6.42) vs. 30 (1.83); mean difference 6.04 (95% CI: 3.46 to 8.62), p = 0.005]. This also led to a reduction in the additional X-ray exposure in the US group (n = 11) compared to the SD group (n = 20) [95% CI: 3.12 to 44.26; p = 0.020]. Ultrasound-guided UVC insertion significantly reduced the rate of catheter tip malposition. It also reduced the number of attempts at catheter manipulation, procedure time, and X-ray exposures. With adequate training, it could be incorporated into routine bedside practice during UVC insertion for optimum placement. Clinical Trial Registry of India ( www.ctri.nic.in ) CTRI/2021/03/031894.

Pediatric Hepatic Cystic Lesions: Differential Diagnosis and Multimodality Imaging Approach.

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.

Application and Nursing Countermeasures of Umbilical Vein Catheterization in Premature Infants

Application and Nursing Countermeasures of Umbilical Vein Catheterization in Premature Infants

Supraventricular tachycardia and cardiac embolization following umbilical vein catheterization

Abstract Umbilical venous catheter is a routine procedure in the neonatal intensive care unit used in securing intravenous access for various purposes, but malpositioning of this catheter can lead to life-threatening complications. We report the case of a female infant of a mother with gestational diabetes who was admitted in the special care baby unit at 1 h of life for prematurity, hypoglycemia, and presumed neonatal sepsis. She developed supraventricular tachycardia (SVT) within 24 h of having an umbilical catheter inserted for intravenous access; she later developed multiple intracardiac emboli. She was treated with digoxin, frusemide, Aldactone, heparin, antibiotics, and dextrose with the resolution of the intracardiac emboli. This case highlights some of the uncommon but serious risks of umbilical catheterization, which could be SVT and the possibility of developing an intracardiac embolus. In resource-poor settings where ultrasound-guided umbilical catheterization is limited, cardiac arrhythmias should be recognized as a potential complication of umbilical catheterization, which requires early intervention and treatment.

Acute Kidney Injury in the Neonatal Intensive Care Unit: Incidence and Risk Factors

Introduction and Aim: Acute Kidney Injury (AKI) is a common medical problem, especially in neonatal intensive care unit. However, the reported incidences and associated risk factors are widely heterogenous and sometimes absent for developing countries. Thus, the current work designed to explore the incidence and potential risk factors of AKI for critically ill neonates.&#x0D; Patients and methods: The current work was an observational prospective study, completed between March 2019 and March 2022. It included 459 newborns admitted to the NICUs at Al-Azhar University Hospital (New Damietta) and Damietta General Hospital (Ministry of Health, Damietta, Egypt). For all neonates, careful history and clinical examination were done and data was documented. Then, repeated creatinine measurements and arterial blood gas analysis were performed. Discharge or death was the primary end point of the study. Other comorbid conditions were the secondary outcome.&#x0D; Results: The incidence of AKI was 92.2% and there was no significant difference between AKI and non-AKI regarding neonatal age, sex and mode of delivery. Patients with AKI had significantly lower gestational age, reduced birth weight, pH and HCO3. The serum creatinine showed significant increase during the first week of NICU admission in AKI than non-AKI groups, while basal values did not. Sepsis, nephrotoxic medications, hypoxic ischemic encephalopathy, umbilical catheter, duration of admission and mortality, all were significantly higher in AKI than non-AKI groups. Sepsis was reported among 44.8% and 27.7%, while mortality was reported for 20.9% and 4.9% of AKI and non-AKI groups, respectively. The duration of admission was 15.25±3.19 vs 9.50±2.21 days respectively.&#x0D; Conclusion: AKI was relatively higher (29.2% of admitted neonates) and associated with prematurity and lower birth weight. Neonatal sepsis and exposure to nephrotoxic drugs were among the commonest predisposing factors for AKI.

Comparison of Central Venous Cut-DownVersus umbilical venous Catheterization in Neonates

Comparison of Central Venous Cut-DownVersus umbilical venous Catheterization in Neonates

Central line-associated bloodstream infection (CLABSI) with three different vascular access in neonatal intensive care unit

BackgroundCentral venous catheters (CVCs) are a mandatory aspect in the neonatal intensive care units. Unfortunately, bloodstream infection is a frequent complication of CVCs. A needleless connector is attached to the end of CVC to allow infusion of fluids. We aimed to assess the effect of needleless connectors on central line-associated blood stream infection, and to assess rate of occurrence of bloodstream infection with the use of three different types of venous access in neonates.MethodsThis study is a prospective, randomized, comparative study which was held at the Neonatal Intensive Care, Faculty of Medicine, Ain Shams University. The study recruited 120 neonates who were categorized into three groups according to the type of inserted CVC: group A with umbilical venous catheter, group B with peripherally inserted central catheter, and group C with non-tunneled central venous catheter, and each group was further subdivided into two groups according to the use of needleless connector. Criteria of central line-associated bloodstream infection (CLABSI) and central line-related bloodstream infection (CLRBSI) were applied.ResultsThe study included 120 neonates, a multivariable logistic regression analysis was held for two predictors (type of CVC and use of needleless connector) of CLABSI/CLRBSI, it revealed that the use of needleless connector was associated with significant lower incidence of CLABSI/CLRBSI (P value < 0.05, adjusted odds ratio [aOR] = 0.303), the use of peripheral inserted central catheter (PICC) was also associated with the lowest incidence of CLABSI/CLRBSI (P value = 0.015, aOR = 0.284). Another multivariable logistic regression analysis was done for four predictors (type of CVC, use of needleless connector, gestational age, and catheter dwell time) which revealed that the gestational age (P value = 0.001, aOR = 0.691) and catheter dwell time (P value = 0.004, aOR = 1.313) were the only independent predictors for the occurrence of CLABSI/CLRBSI.ConclusionThe use of needleless connector can lower the incidence of CLABSI/CLRBSI, PICC line was associated with the lowest incidence of CLABSI/CLRBSI among the three types of CVCs. Low gestational age and long catheter dwell time were found to be the main risk factors for increasing the incidence of CLABSI/CLRBSI.

Retrieval of a Broken Umbilical Artery Catheter in a Neonate

Background Umbilical arterial catheterization is an extremely useful tool in the premature, sick neonate for intensive monitoring and as a source of arterial blood sampling. We describe the case of an inadvertent breakage of an umbilical artery catheter (UAC), to replace it, and the potential complications that can arise. Case Report A premature 33-week infant weighing 1.965 kg was admitted to the neonatal intensive care unit (NICU) and had umbilical catheterization. An abdominal X-ray (AXR) was done following the procedure to confirm the position, and the UAC was found to be too low, between T11 and T12. In attempting to replace it, the UAC was transected, with the umbilical stump bleeding, and the internal tip not seen. The patient underwent laparotomy and examination under anesthesia revealed a UAC that was palpable in the right lower quadrant and fluoroscopy revealed a tip in the external iliac artery. This migrated with each subsequent palpation. Meticulous dissection revealed a catheter which was palpable in the right internal iliac artery. The bifurcation was cleared, and vascular slings applied, getting proximal and distal control. The vessel was opened, and the catheter retrieved in its 15-cm entirety. The vessel was repaired with 7/0 Prolene suture. Conclusions This case is intended to highlight that even a trivial procedure of UAC removal must be done carefully with appropriate instrumentation to prevent this complication. For retrieval of this type of vascular foreign body, an open technique can be used with the assistance of fluoroscopy. Endovascular retrieval techniques are also an option but are not available in our setting for this age group.

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases.

In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.

50 Years Ago in TheJournalofPediatrics: Umbilical Arterial Catheter and Umbilical Vessel Catheterization Use and Complications

50 Years Ago in TheJournalofPediatrics: Umbilical Arterial Catheter and Umbilical Vessel Catheterization Use and Complications

A Single-Center 5-Year Experience of Iatrogenic Vascular Injuries and Their Outcomes

Introduction: Diagnostic and therapeutic interventions can lead to iatrogenic vascular injuries (IVIs). The spectrum of IVIs, their management, and outcomes is presented. Materials and Methods: This prospective observational study from January 2016 to December 2020, included all successive IVIs managed by the vascular surgery department. IVI was defined as vascular injury manifesting as hemorrhage/vessel occlusion/and/or retained foreign body in vasculature. Those due to trauma and/or &lt;30 days follow-up were excluded. Reasons for IVI, presentation, vessels involved, and outcomes were analyzed. Results: Thirty-eight IVIs were analyzed. Age ranged from 3 days to 77 years. Sixteen were due to cardiology, seven due to orthopedics, four cases in end-stage kidney patients, 4 cases due to invasive arterial monitoring, and two following cardiac surgery. One case each was following laparoscopy, spine surgery, thrombectomy, endovascular aneurysm repair, and umbilical catheterization. Manifestations were limb ischemia (lower limb-13, upper limb-6), pseudoaneurysms-10, retained foreign body-4 (superior vena cava and/or right atrium-3; external iliac artery-1), hemorrhage-2, arterio-venous fistula-2, and compartment syndrome-1. Common femoral artery (with/without superficial femoral artery) was affected in 13, forearm arteries in 8, popliteal artery and crural arteries in three each, and one case, each of profunda femoris, carotid artery, external iliac artery branch, and thoracic aorta. IVIs were managed by thrombectomy in 13, arterial repair in 11, endovascular procedures in 5, bypass in 4, conservative in 3, and by laparotomy and open retrieval of a balloon in one case each. Four developed surgical site infections, three died, three suffered amputations, three had motor deficits, and two developed acute kidney injury. Conclusion: IVIs have heterogeneous presentation. Both open and endovascular skill sets are required for management. IVIs carry high morbidity and mortality.

Changes in oxygen and carbon dioxide in umbilical cord arterial blood before and after the first breath of a newborn to explore the mechanisms of respiratory regulation

The fetus has no actual respiration, and the newborn begins to breathe after birth. We assume that the first breath dominantly generated by hypoxia. In this study, the changes and lowest limit of blood oxygen partial pressure of umbilical artery (PuaO2) after chemoreceptor were analyzed to explore the mechanism of neonatal spontaneous breathing.MethodsWith signed consent form by all fetal parents before birth, 14 newborns successfully completed the umbilical artery or vein catheterization and drawn blood according to the heartbeat. All blood samples analyzed by blood gas analyzer, calculated and analyzed the similarities and differences between umbilical vein(Puv) and umbilical artery(Pua).ResultsAlthough we completed 14 newborns, there were only 9 cases of umbilical artery samples and 8 cases of umbilical vein samples were collected. Only 3 cases collected both Pua and Puv blood samples at the same tim (see serial paper II). PuaO2 in gradually decreased with time (heartbeat frequency), until Pua contracted after spontaneous breathing produced about 8‐10 heartbeats, and then could not get enough blood samples. Only 3 newborns were able to take blood samples after spontaneous breathing for 8‐10 heartbeats, and PuaO2 jumped to 93.8,137.0 and 93.8 respectively The mean value of PuaO2 was 25.94±6.79 (range 18.04‐37.55)mmHg, the highest value was 32.41±11.97 (range 23.0‐61.0) mmHg, and the lowest value was 22.18±6.35 (range 14.0‐33.6)mmHg. Although PuvO2 decreased gradually with time (heartbeat) too, most of them also showed the tendency of alternately rising and falling with the regularity of mother’s respiration. The mean value of PuvO2 was 50.35±21.35 (range 32.56‐100.73)mmHg, the highest value was 90.34±8.44 (range 43.4‐153.0)mmHg, and the lowest value was 36.96±14.90 (range 24.8‐73.8)mmHg, although.ConclusionPuaO2 decreases gradually with time before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

Term Infant with Bilateral Parenchymal Brain Hemorrhages.

Term Infant with Bilateral Parenchymal Brain Hemorrhages.