Umbilical Catheter Research Articles

Neonatal Ventricular Tachycardia after Insertion of an Umbilical Venous Catheter

Neonatal Ventricular Tachycardia after Insertion of an Umbilical Venous Catheter

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Practical procedures for the delivery room resuscitation of micropreemies

There are no standardized procedures for the resuscitation of micropreemies but respiratory and circulatory stabilization immediately after birth should be prioritized. Without aggressive support by positive pressure ventilation, establishing effective respiration among micropreemies is not possible. The first step in postnatal stabilization is initiated by positive airway pressure with a bag and mask. Once the heart rate increases above 100 beats/m, intratracheal intubation should be achieved because it is unusual for a micropreemie to breathe spontaneously or by non-invasive respiratory support for a protracted duration. Until further information is available, initial FiO2 should be between 0.3 and 0.6, and titrated to achieve SpO2 obtained from healthy term infants for the first 10 min of life. Temperature control of infants is also critical for successful resuscitation and heat-loss minimizing procedures should be used e.g. with insulating bags. After securing the intratracheal tube, the infants should be transferred to the NICU for further procedures, including pulmonary surfactant installation and umbilical cord catheterization. Procedures in a delivery room under a radiant warmer should be limited to the initial resuscitation. In NICUs, the infants should be placed into a closed incubator to maintain high environmental temperature and humidity as well as decrease exposure to intervention and noise. Increased number of staff will also be needed to stabilize the infants further in the NICU. Finally, appropriate equipment (e.g. appropriate sized laryngoscopes) should be made readily available, along with regular practical training and education, whether in person or through SIM courses which are essential for all staff to achieve competence in successful resuscitation of the newborn micropreemie.

Low-lying Umbilical Venous Catheters are not Always Associated with Increased Complications

Low-lying Umbilical Venous Catheters are not Always Associated with Increased Complications

Contrast Enhanced CT-Scan of Aorta Thrombosis in Neonates: Case Report

Aortic thrombosis of the newborn is a rare condition associated with poor functional and vital prognosis. Most cases are related to umbilical arterial catheterization, but other risk factors include sepsis, extreme prematurity, asphyxia and prothrombotic conditions. We present a case of neonatal aortic thrombosis presenting with a lower limb ischemia occurring at the second week after birth in association with respiratory distress. Its imaging features are displayed along with a literature review. The Doppler ultrasonography made the initial diagnosis and Contrast Enhanced Computed Tomography provided precise location and extension of the thrombus. In Conclusion, Doppler Ultrasonography is first-line examination for diagnosis of aortic thrombosis in neonates. However, its lack of anatomic precision makes the Contrast Enhanced Computed tomography the imaging technique of choice in investigation of ischemia due to aortic thrombosis, as it provides the topography and extension of the thrombosis, also identifies the ischemic phenomena of abdominal organs and limbs.

Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease.

Umbilical venous cannulation is the favored approach to perinatal central access worldwide but has a failure rate of 25-50% and the insertion technique has not evolved in decades. Improving the success of this procedure would have broad implications, particularly where peripherally inserted central catheters are not easily obtained and in neonates with congenital heart disease, in whom umbilical access facilitates administration of inotropes and blood products while sparing vessels essential for later cardiac interventions. We sought to use real-time, point-of-care ultrasound to achieve central umbilical venous access in patients for whom conventional, blind placement techniques had failed. Multicenter case series, March 2019-May 2021. Cardiac and neonatal ICUs at three tertiary care children's hospitals. We identified 32 neonates with congenital heart disease, who had failed umbilical venous cannulation using traditional, blind techniques. Real-time ultrasound guidance and liver pressure were used to replace malpositioned catheters and achieve successful placement at the inferior cavoatrial junction. In 32 patients with failed prior umbilical venous catheter placement, real-time ultrasound guidance was used to successfully "rescue" the line and achieve central position in 23 (72%). Twenty of 25 attempts (80%) performed in the first 48 hours of life were successful, and three of seven attempts (43%) performed later. Twenty-four patients (75%) were on prostaglandin infusion at the time of the procedure. We did not identify an association between patient weight or gestational age and successful placement. Ultrasound guidance has become standard of care for percutaneous central venous access but is a new and emerging technique for umbilical vessel catheterization. In this early experience, we report that point-of-care ultrasound, together with liver pressure, can be used to markedly improve success of placement. This represents a significant advance in this core neonatal procedure.

Relationship between central line-associated bloodstream infection and catheter dwell time in neonates

The central line-associated bloodstream infection (CLABSI) is a common and serious complication of central venous catheterization, which can lead to various short-term and long-term adverse outcomes. Neonatal CLABSI did not increase linearly with the prolongation of peripherally inserted central catheter (PICC). When the umbilical venous catheter (UVC) is retained for more than 1-2 weeks, the incidence of neonatal CLABSI may increase significantly; PICC replacement at 7-10 days after UVC indwelling may reduce the incidence of CLABSI, but it has not been supported by evidence-based medicine. This article reviews the related studies between neonatal CLABSI and catheter dwell time, in order to plan the indwelling time more reasonably and prevent CLABSI better.

Foreign body abscess caused by a remaining piece of an umbilical arterial catheter in a 3-year old girl

Since the 1960s umbilical catheterization has been a common method for vascular access, both arterial [1] and venous [2], in the sick newborn. Increased utilization of this procedure has demonstrated a number of complications including catheter related sepsis [3], thrombotic and embolic events [5], hemorrhage [1], limb ischemia, dissection of vessels, hypertension, congestive heart failure, visceral gangrene, necrotizing enterocolitis and liver abscesses [4]. Abscesses caused by umbilical arterial catheters (UAC) however are very rare in comparison to other complications. Most of the complications were reported during or just after the removal of the umbilical arterial catheter. We would like to present this very uncommon case of a late onset abscess lateral to the bladder caused by a remaining piece of a transected UAC in a 3-year old girl.

Know the Code: Medications for Resuscitation in Neonates.

Resuscitations in the delivery room or the nursery cause significant stress for caregivers. Diligent preparation will improve the efficacy and safety of life-saving interventions and increase staff comfort. When establishment of an airway and delivery of positive pressure ventilation and chest compressions fail to result in return of spontaneous circulation, pharmacotherapeutic interventions should be considered. Epinephrine is first-line pharmacotherapy for severe bradycardia or cardiac arrest, increasing coronary arterial pressure and blood flow during chest compressions. Despite limited data regarding dosing and efficacy, the first dose of epinephrine may be delivered through the endotracheal tube during attainment of venous access (preferably a low-lying umbilical venous catheter in the delivery room). Intravenous dosing is preferred, and any facility caring for newborns must ensure optimized logistics including readily available dosing guidance and optimal flush volumes. After provision of epinephrine, additional medications may be considered, especially for resuscitations occurring outside of the immediate perinatal period, including normal saline, glucose, adenosine, atropine, and calcium. Clinicians must understand the indications, dosing, and monitoring parameters for these medications and ensure rapid availability for resuscitation. Every second truly counts in a neonatal resuscitation, and optimal understanding and preparation will ensure delivery of pharmacotherapy to optimize both patient outcomes and staff comfort.

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

Real-time US use for line tip positioning in the NICU significantly decreased the number of X-rays performed and was associated with better-positioned lines, decreased irradiation and cost. • The use of point-of-care ultrasound (PoCUS) by critical care providers in neonatology has increased in recent years. International guidelines advocate for the use of PoCUS as valid guidance to practical procedures in neonatology. • Central catheters (umbilical catheters and neonatal peripherally inserted central catheters) are among the most commonly used devices to support NICU patients. Proper positioning is crucial to avoid complications and PoCUS has high sensitivity and specificity in accurately determining line tip position. The current standard practice for line tip position confirmation in neonatology is still conventional radiography despite multiple evidence suggest significant inaccuracy of X-ray compared to ultrasound. • PoCUS implementation for line tip positioning leads to a significant decrease in the number of X-rays performed, in radiation effective dose and costs. PoCUS evaluation of central catheters significantly increases the accuracy of the final line tip position with more lines at the cavoatrial junction. • Training is fundamental for univocal interpretation of ultrasound images and an effective learning strategy is being proposed.

Neonatal Vascular Access Practice and Complications: An Observational Study of 1,375 Catheter Days.

Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vascular access device insertion and management practices, and describe the incidence and risk factors for complication development. This is a prospective cohort study of neonates requiring vascular access devices over 3 months in an Australian quaternary-referral neonatal intensive care unit. In addition to describing current practices, primary outcomes were device failure, complications, and skin complications. Results are reported using descriptive statistics and with risk factors calculated via Cox proportional hazards regression. A total of 104 neonates required 302 vascular access devices, over 1375 catheter days. Peripheral intravenous catheters (PIVCs) were most used (n = 186; 62%), followed by umbilical venous catheters (n = 52; 17%). Insertion attempts were often undocumented; but for those recorded, 5% of devices (n = 15) required 4 attempts or more. Device failure occurred in 28% (n = 82), at an incidence rate of 62.5 per 1000 catheter days (95% confidence interval [CI] 49.7-75.9). Failure was most frequent in PIVCs (37%; n = 68), peripheral arterial catheters (33%; n = 2), and peripherally inserted central catheters (20%; n = 6). Infiltration and extravasation were the most frequent cause of PIVC failure (12%; n = 35). A birth weight less than 1500 g was associated with a significant decrease in PIVC failure (hazard ratio 0.58; 95% CI 0.34-0.99).

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

The umbilical venous catheter (UVC) is one of the most commonly used central lines in neonates. It can be easily inserted soon after birth providing stable intravenous access in infants requiring advanced resuscitation in the delivery room or needing medications, fluids, and parenteral nutrition during the 1st days of life. Resident training is crucial for UVC placement. The use of simulators allows trainees to gain practical experience and confidence in performing the procedure without risks for patients. UVCs are easy to insert, however when the procedure is performed without the use of ultrasound, there is a quite high risk, up to 40%, of non-central position. Ultrasound-guided UVC tip location is a simple and learnable technique and therefore should be widespread among all physicians. The feasibility of targeted training on the use of point-of-care ultrasound (POCUS) for UVC placement in the neonatal intensive care unit (NICU) among neonatal medical staff has been demonstrated. Conversely, UVC-related complications are very common and can sometimes be life-threatening. Despite UVCs being used by neonatologists for over 60 years, there are still no standard guidelines for assessment or monitoring of tip location, securement, management, or dwell time. This review article is an overview of the current knowledge and evidence available in the literature about UVCs. Our aim is to provide precise and updated recommendations on the use of this central line.

Fifteen years of central catheter applications and outcomes in intensive care patients: A single-center pediatric experience.

To investigate the clinical outcome of central line placement in the pediatric age group and to evaluate the risk factors for central line-associated bloodstream infection (CLABSI). We retrospectively examined the outcomes and CLABSI risk factors of pediatric patients aged 0-17 years admitted to intensive care units who had central catheters placed between January 2005 and December 2020. Of the 2718 catheter admissions, 1502 catheter admissions were eligible for the regression and other outcome analyses. Fifty-seven percent of the study group were umbilical artery and vein catheters and 43% were other central catheter admissions, including ultrasound-guided catheter admissions. Logistic regression analysis showed us that right internal jugular vein (RIJV) (OR = 1.5, 95% CI = 1.15-2.02, p = 0.030) was the insertion site and ultrasound-guided interventional radiology catheter placement was the technique (OR = 1.7, 95% CI = 1.07-2.90, p = 0.024), duration of catheter stay (OR = 1.07, 95%CI = 1.06-1.08, p < 0.001), catheter placement in patients older than 2 years (OR = 2.42, 95% CI = 1.69-3.45, p < 0.001), were risk factors for CLABSI. Although CLABSI has variable risk factors, the most important risk factor seems to be the length of catheter stay.

Acquired anterior abdominal wall defect in a neonate following umbilical catheterization: a case report

Congenital anterior abdominal wall defects are well known clinical entities. However, acquired abdominal defects are uncommon.

Effect of Nursing Interventions on Nurses' Performance regarding Care Provided to Neonates Undergoing Umbilical Venous Catheter

Effect of Nursing Interventions on Nurses' Performance regarding Care Provided to Neonates Undergoing Umbilical Venous Catheter

Portal Vein Gas in Neonates: Predicting Clinical Treatment Outcomes From Ultrasound Findings.

To identify sonographic findings that predict clinical outcomes in neonates with portal vein gas. This retrospective study included neonates with portal vein gas detected using ultrasound (US). The US images were reviewed by a pediatric radiologist. US findings included the extent and amount of portal vein gas, mesenteric vein gas, intramural gas, bowel wall thickening or thinning, focal discontinuity of the bowel wall, ascites, free intra-abdominal gas, pseudocyst, gas in the other solid organs, and bowel distension. The imaging findings and demographic factors between survivors and non-survivors were statistically compared. The mortality rate was 26% (39 survivors, 14 non-survivors) when iatrogenic and idiopathic causes were excluded. The causes of portal vein gas were determined to be necrotizing enterocolitis (n=33), bowel distension or obstruction (n=12), fetal hydrops (n=4), pneumothorax (n=3), immediate postoperative state for bowel perforation (n=1), and umbilical vein catheterization (n=9) based on surgical findings (n=20) and clinical information (n=46). Gas within the mesenteric vein and the other solid organs, gestational age, and birth weight were significantly different between survivors and those who succumbed (P < .05). Gas within the mesenteric vein and other solid organs is a US finding that may predict poor outcomes in neonates with portal vein gas.

Study on Nursing Effect of Umbilical Vein Catheterization in Premature Infants

Study on Nursing Effect of Umbilical Vein Catheterization in Premature Infants

Malpositioned umbilical venous catheter after thoracoscopic repair of diaphragmatic eventration

Diaphragmatic hernia and eventration of the diaphragm as congenital defects have similar clinical and radiological presentations. The umbilical venous catheter is successfully used for venous access in a neonatal age group with minimal complications. We present a case of a two-day-old neonate, initially scheduled for thoracoscopic repair of right diaphragmatic hernia. But, the intraoperative evaluation revealed the right diaphragmatic eventration. After initial ventilation and optimization in the neonatal intensive care unit, the baby was taken up for thoracoscopic repair under general anesthesia. The postoperative abdominal radiograph showed migration of umbilical vein catheter into the portal vein cephalad. The possible explanation is liver reposition to standard anatomical localization upon surgical correction. The catheter was uneventfully pulled back to its optimal position.

Successful Treatment of Cardiac Tamponade Associated with Umbilical Venous Catheter by Pericardiocentesis in Two Neonates: Two Case Reports

Successful Treatment of Cardiac Tamponade Associated with Umbilical Venous Catheter by Pericardiocentesis in Two Neonates: Two Case Reports

Extrahepatic Portal Vein Thrombosis in Childhood: Risk Factors, Clinical Manifestations, and Management

Objective: Extrahepatic portal vein thrombosis (EHPVT) is a common cause of portal hypertension in children. The aim of the present study was to identify the clinical manifestations and the risk factors for development of EHPVT in pediatric patients. Subjects and Methods: This was a single-center retrospective cohort study. A total of 12 children (6 boys and 6 girls) took part in the study. We noted the clinical presentations and the predisposing risk factors for development of EHPVT in all patients. In addition, as all of them had undergone an esophagogastroduodenoscopy for detection and grading of esophageal varices as part of the treatment algorithm, we analyzed the endoscopic findings and the therapeutic approach. Results: The median age of subjects at diagnosis was 3.5 years (range: 1–17 years). The most frequent initial clinical manifestation was upper gastrointestinal bleeding (6 cases, 50.0%) followed by splenomegaly (3 cases, 25.0%). The most frequent systemic risk factor for EHPVT was presence of inherited prothrombotic disorder (10 cases, 83.3%), and the most common local risk factor for EHPVT was umbilical vein catheterization (5 cases, 41.7%). Esophageal varices were revealed in all the study participants, and in the most cases, they were grade ≥2. Propranolol was used as primary or secondary prophylaxis in 7 children (58.3%), and in 5 children (41.7%), a shunt was performed (Meso-Rex bypass in 3 children and splenorenal shunt in 2 children). Conclusion: Patients with known systemic or local risk factors for EHPVT are indicated for proactive ultrasound screening for early diagnosis and timely management.