Umbilical Venous Catheter Insertion Research Articles

Affordable Implementation of a Point-of-Care Ultrasound Program in a Large Tertiary Neonatal Intensive Care Unit to Assess Umbilical Venous Catheter Tips and Aid Central Placement.

This study aimed to implement a point-of-care ultrasound (POCUS) program into a large neonatal intensive care unit (NICU) to enhance care by improving (1) umbilical venous catheter (UVC) tip identification and (2) central placement. A POCUS program was established with core providers who received training from external and internal experts. A prospective study (n = 94) compared the accuracy of UVC identification between neonatology-performed ultrasound (NeoUS) and X-ray relative to a referent of radiology-interpreted ultrasound. Finally, an ultrasound-guided UVC insertion protocol was introduced to rescue noncentral traditionally placed catheters (n = 37). Program implementation trained six providers for a total cost of approximately $10,500 USD. NeoUS was more accurate than X-ray at identifying UVC location (81.9 vs. 60.6%) with improved sensitivity and specificity (80.0 and 84.6 vs. 52.5 and 66.7%, respectively). POCUS guidance was able to rescue 89.2% of catheters that were originally noncentral. POCUS implementation in a large NICU is feasible, affordable, and can improve quality of care. · POCUS implementation is feasible and affordable.. · POCUS is more accurate than X-ray at monitoring UVCs.. · Central UVC placement can be increased with POCUS..

Umbilical Venous Catheter Position Evaluation in Hasan Sadikin General Hospital : Overview of the Time Required

Background: An umbilical venous catheter (UVC) is one of the most frequently used access in neonates. In developed countries, bedside ultrasonography (USG) is used in assessing the position of the UVC catheter’s tip. However, this is difficult to be implemented in developing countries. In Indonesia, which categorized as a middle- income developing country, the evaluation of UVC mainly used chest radiographs. However, this procedure would take time. The delay in ascertaining UVC positioning through chest radiography among neonatologists in Indonesia remains unstudied, despite its potential on the clinical efficacy. Therefore, this study aimed to determine the time required for the installation of the UVC and the interval from the completion of UVC insertion until the release of the chest radiography result. Method: In this prospective observational cohort study, neonates requiring UVC access were examined in Dr. Hasan Sadikin Hospital in Bandung, West Java. Patients underwent anthropometric measurements and UVC installation. Duration required for UVC installation and the interval between the completion of UVC insertion and the release of the chest radiography result were documented. Descriptive data were shown in percentage, mean and standard deviation. Result: 127 neonates were studied. The average time taken for UVC insertion was 31 minutes and the average time taken from the completion of UVC insertion until the release of chest radiography results was 6 hours. Conclusion: The long wait for chest radiography results significantly delayed the administration of fluids, medications, and parenteral nutrition in this study. Therefore, we need alternative tools to evaluate the UVC location that can be used bedside right after the installation.

Comparison of Ultrasound-Guided Umbilical Venous Catheter Insertion with Blind Method: A Randomized Controlled Trial

Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36–1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion.

Accuracy of Shukla’s formula for depth of insertion of umbilical venous catheter

Background: The use of umbilical venous catheter (UVC) is an essential part of neonatal care allowing delivery of intravenous fluids, nutrition, and medication. It is important to know the position of the UVC tip accurately at the first attempt to prevent complications and minimize handling. We aimed to determine the precision and accuracy of Shukla’s formula developed to guide UVC placement and to evaluate the probability of UVC placement at desired radiological markings using weight-based Shukla’s formula. Methods: This study was carried out at NICU in NRI medical college, a tertiary care center in Chinakakani, Andhra Pradesh, India. A prospective observational study was done from December of 2021 to September 2022. With an aim to study the accuracy of Shukla's formula in assessing the depth of insertion of UVC, depth was calculated and position of the tip of the catheter confirmed by x-ray. Results: We have taken 138 neonates in our NICU unit with mean gestational age of 33.91 wks. and with mean birth weight of 1.91 kg. Out of 138 infants 99 had a successful ideal UVC placement using Shukla's formula. In reference to gestational age out 83 newborns in gestational age between 32-36 weeks 62 had ideal placement of UVC. In reference to birth weight ideal position of the UVC was seen in 73% of newborns. Conclusions: Shukla’s formula provided a reasonably accurate probability of achieving ideal UVC position in most of our babies: accurate in 72%.

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.

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.

Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates – A Prospective Diagnostic Evaluation study

To evaluate the diagnostic accuracy and utility of bedside ultrasound (US) by neonatology residents to confirm position of umbilical venous catheter (UVC), umbilical arterial catheter (UAC), and peripherally inserted central catheter (PICC). In this prospective study, we included neonates who required UVC, UAC or PICC insertion. Two neonatology residents performed all bedside US examinations after a short period of training. Plain radiograph was taken as gold standard. Time taken for confirmation of catheter position by US and radiograph was recorded. We recruited 71 neonates for UVC and UAC, and 40 neonates for PICC. Sensitivity and specificity of US in identifying a malpositioned catheter was good for UVC (94% and 66.7% respectively) and UAC (86.7% and 94.5%). Agreement between radiograph and US was good for UVC [0.718 (0.512, 0.861); p < 0.001] and UAC [0.857 (0.682, 0.953); p < 0.001]. Sensitivity (47.8%) of US in identifying a malpositioned PICC was low, though specificity (82.4%) was good. Agreement between radiograph and US in identifying PICC position was poor [0.25 (-0.084, 0.545); p 0.024]. This was due to incorrect interpretation of catheter position on radiograph in some infants, which was confirmed by the radiologist. The median time taken for US was significantly less than time taken for radiograph in confirming the position of UVC (50 vs. 155 minutes; p < 0.001)), UAC (45 vs. 128 minutes; p < 0.001), and PICC (60 vs. 136 minutes; p < 0.001). US examination byneonatology residents has good diagnostic accuracy in confirming the position of UAC and UVC, and possibly PICC in neonates. The time taken to confirm catheter position by US is significantly less than radiograph.

Ultrasound-Guided Umbilical Venous Catheter Insertion With Alignment of the Umbilical Vein and Ductus Venosus.

Previous studies have highlighted the importance of confirming the position of an umbilical venous catheter (UVC) tip by an ultrasound (US) examination. However, methods for preventing insertion into the portal circulation under US guidance have not yet been established. We report 15 cases in which a UVC was successfully passed through the ductus venosus by compressing the upper abdomen near the portal sinus of the liver to align the umbilical vein and ductus venosus under US guidance. The UVC was inserted into the correct position in 14 of the 15 neonates (93%) without complications.

Umbilical venous catheter insertion depth estimation using birth weight versus surface measurement formula: a randomized controlled trial

To determine if umbilical venous catheter (UVC) insertion depth estimated by surface measurement (SM) results in optimal catheter tip position on ultrasound as compared with formula using birth weight (BW). In this randomized controlled trial, eligible infants were randomized to UVC insertion depth estimated by SM or BW method. We compared proportion of optimum UVC position on ultrasound read by neonatologist masked with group assignment. UVC was inserted to estimated depth in 164 of 200 enroled infants. There was no difference in the proportion of correctly positioned UVCs between the groups (SM 33/82 (40.2%) vs BW 27/82 (32.9%), p = 0.33). Among BW < 1000 g, SM method had higher correctly positioned UVC (43.7% vs 22.5%, p = 0.07). There was no difference in the rate of optimally positioned UVC tip between the two methods for estimating UVC insertion depth. However, SM method results in more optimal positioning of UVC tip among BW < 1000 g infants.

Comparison of JSS Formula with Modified Shukla’s Formula for Insertion of Umbilical Venous Catheter: A Randomized Controlled Study

To compare the rate of optimal position of UVC between modified Shukla's formula and JSS formula. Babies requiring umbilical vein catheterization were randomized to either Shukla or JSS formula group. Post-procedure X-ray was taken to check the tip position. Tip of the UVC just above the diaphragm (T9 - T10) was considered optimal. Success rate in achieving optimal position between the two groups were compared. Out of 104 babies recruited, 50 were randomized for Shukla's formula and 54 for JSS formula. Catheter tips were in acceptable positions in 39.6% of Shukla group as compared to 56% in JSS group (P=0.02). The JSS Formula resulted in more optimal placement of UVC than the modified Shukla formula.

Comparing two formulas to estimate the correct depth of the neonatal umbilical venous catheter insertion

Aim The rate of complications among neonates with incorrectly positioned umbilical venous catheters (UVCs) is considerably increased. This prospective study aimed to evaluate whether the use of birth weight (BW) or body surface measurements as a guide for proper depth estimation of the UVC insertion was more accurate. Patients and methods A total of 104 neonates were assigned to two groups according to procedure used for proper UVC depth insertion: shoulder–umbilicus length graphs versus BW-based formula. Radiological assessment of correct catheter tip position was determined in both groups. Results The overall success rate for UVC insertion was 96% (100/104). However, in 51% (48/94) of the neonates, the UVC was not advanced to the estimated depth. Comparing infants whose UVC was secured at the correct depth and was not in the liver between the weight and measurement method, there was no significant difference in the appropriate site radiologically, but none of catheters not secured at the estimated depth were in appropriate site radiologically in the weight group, whereas some of catheters not secured at the estimated depth were in appropriate site radiologically in the measurement group, with significant difference. However, the weight method shows more sensitivity and accuracy when compared with the measurement group (100 and 75% vs. 50 and 50%, respectively), with the same specificity at 50% each. Conclusion A correct depth of insertion was more accurately achieved and showed a higher sensitivity using the BW formulae compared with the body surface measurement method.

Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice.

Background: Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants. Methods: A pre–post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA) was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period. Results: During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%). Conclusion: Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.

Accuracy of chest radiography for positioning of the umbilical venous catheter

ObjectivesTo evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks–diaphragm, cardiac silhouette, and vertebral bodies–when determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. MethodsThis was a cross‐sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. ResultsOf the 162 newborns assessed by echocardiography, only 44 (27.16%) had the catheter in optimal position, in the thoracic portion of the inferior vena cava or the junction between the inferior vena cava and the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33%) newborns, in the right atrium in 26 (16.05%), intra‐hepatic in 37 (22.84%), and intra‐aortic in ‐one newborn (0.62%). The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. ConclusionAnteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter.

Umbilical Venous Catheter Malposition Is Associated with Necrotizing Enterocolitis in Premature Infants

Objective: The etiology of necrotizing enterocolitis (NEC) remains elusive despite known associations with several factors, including intestinal ischemia related to the effects of umbilical arterial catheterization on the mesenteric circulation. However, the role of the mesenteric venous circulation has yet to be studied as a potential cause of NEC. We examined the association between umbilical venous catheter (UVC) position and the development of NEC in premature infants. Design: A prospective cohort study was performed to examine the effect of UVC on portosystemic shunting via the ductus venosus (DV) and its potential role in NEC. Results: We recruited 132 premature infants, 62 of which had a birth weight ≤1,500 g. NEC was noted in 12 (19%) patients. All infants weighing ≤1,500 g underwent an attempt at UVC insertion. The UVC status was classified as appropriate (n = 39), unsuccessful (n = 9), or malpositioned (n = 14). Among the NEC patients, 7 (58%) had a UVC malposition and 3 (25%) had an unsuccessful attempt. These rates were significantly higher than in patients without NEC (14 and 12%, respectively). Multivariable logistic regression analysis confirmed birth weight (OR 2.2, 95% CI 1.2-4.7, p = 0.001) and UVC malpositioning (OR 6.9, 95% CI 1.6-35.4, p = 0.007) as independent risk factors associated with NEC. Conclusions: Unrecognized withdrawal of a UVC into the portal vein or DV is associated with an increased incidence of NEC in infants weighing ≤1,500 g. The data support the need for additional studies to examine this effect. Confirmation of a causal relationship will raise the need to reassess UVC insertion criteria and strategies for more closely monitoring the catheter tip position.

Positioning newborns on their back or right side for umbilical venous catheter insertion

目的 新生儿仰卧位时进行脐静脉导管留置，导管尖端的位置通过X-线确定。当导管尖端在下腔静脉时定为位置正确。我们希望确定新生儿右侧卧位，而不是仰卧位时，留置脐静脉导管可以使导管放置更准确。 方法 放置导管时，随机将新生儿置于仰卧位或者右侧卧位。主要结果通过X-线判断导管尖端的位置正确(膈肌水平中线可见)。 结果 所有新生儿脐静脉导管留置成功。两组间导管放置位置准确率无明显差异[仰卧位23/44(52%)，右侧卧位27/44(61%)，P=0.389]。新生儿仰卧位导管更易进入门脉[仰卧位13/44(30%)，右侧卧位5/44(11%)，P=0.034]。 结论 新生儿右侧卧位留置脐静脉导管并未增加导管位置的正确性。这一方案易于接受并且减少导管尖端进入门脉循环的概率。

Positioning newborns on their back or right side for umbilical venous catheter insertion.

Newborns are placed supine for umbilical venous catheter insertion, and catheter tip position is confirmed with X-ray. Umbilical venous catheters are considered correctly positioned when the tip is in the inferior vena cava; however, frequently, the catheter tip enters the portal venous circulation. We wished to determine whether placing infants on their right side, rather than on the back, for umbilical venous catheter insertion results in more correctly placed catheters. Newborns were randomised to be placed on their back, or turned onto their right side for catheter insertion. Primary outcome was correct catheter tip position on X-ray (visible in the midline at diaphragm level). Umbilical venous catheter insertion was successful in all infants enrolled. There was no difference in the proportion of correctly positioned catheters between the groups [back 23/44 (52%) versus right side 27/44 (61%), p = 0.389]. More infants randomised to back had the catheter tip in the portal circulation [back 13/44 (30%) versus right side 5/44 (11%), p = 0.034]. Positioning newborn infants on their right side did not result in more correctly placed umbilical venous catheters. The procedure was well tolerated and reduced the rate of tip insertion into the portal venous circulation.

Accuracy of chest radiography for positioning of the umbilical venous catheter

ObjectivesTo evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks – diaphragm, cardiac silhouette, and vertebral bodies – in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. MethodsThis was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. ResultsOf the 162 newborns assessed by echocardiography, only 44 (27.16%) had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33%) newborns, in the right atrium in 26 (16.05%), intra-hepatic in 37 (22.84%), and intra-aortic in-one newborn (0.62%). The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. ConclusionAnteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter.

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

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.

Superiority of targeted neonatal echocardiography for umbilical venous catheter tip localization: accuracy of a clinician performance model

To compare targeted neonatal echocardiography (TnECHO) and antero-posterior (AP) chest radiographs in the localization of the umbilical venous catheter (UVC) tip and to determine the accuracy of UVC tip localization by TnECHO when performed by a trained cohort of pediatric housestaff physicians. Prospective, observational study of consecutive neonates requiring UVC insertion, in a tertiary care center, in an 18-month period. Chest radiographs reporting optimal position of the UVC tip were compared with the TnECHO results of the pediatric cardiologist. The latter was also compared with the results of TnECHO performed by the pediatric housestaff physicians. Thirty neonates with birth weight ranging between 270 and 4490 g and gestational age ranging between 24 and 44 weeks were enrolled. Nine patients (27%) required UVC tip repositioning as the cardiologist performed TnECHO revealed sub-optimal tip position despite optimal position on chest radiography. Among them, four had the UVC tip in the right atrium and five in the left atrium. Compared with the cardiologist, the housestaff physicians had reported TnECHO with a high-accuracy rate (area under the receiver operating characteristic curve=0.81). TnECHO is superior to chest radiography for identifying malpositioned catheters. TnECHO performed by pediatric housestaff physicians with basic training, demonstrated high-accuracy rates.