Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

Overview

Journal Neonatology

Publisher Karger

Specialty Gynecology & Obstetrics

Date 2019 Jan 16

PMID 30645997

Citations 8

Authors

Gerdina H Dubbink-Verheij

Remco Visser

Ratna N G B Tan

Arno A W Roest

Enrico Lopriore

Arjan B Te Pas

Affiliations

Soon will be listed here.

Abstract

Background: Migration of umbilical venous catheters (UVCs) has been described anecdotally.

Objectives: The aim of this paper was to investigate migration of UVCs using ultrasonography (US).

Methods: In a prospective observational study, the position of UVCs was determined using serial US within 24 h, at midweek, and at the end of the week after umbilical catheterization. Migration was recorded in distance and direction. Malposition was defined as a position of the UVC in the heart (right atrium or more distal along the UVC-route), umbilicoportal confluence, or in the umbilical vein. UVC position determined by US was compared with chest X-rays (CXRs) when these were performed for standard care within the same period of 1 h.

Results: Migration of UVCs was detected with US in 25/40 infants (63%) in 32 occasions, leading to malposition in 17/25 (68%) infants. UVCs migrated inwards in 18/32 (56%), leading to a position within the heart in 17/18 occasions. Most migrations occurred before Day 3 (21/32 [66%]). When a CXR was taken at the same time as US was performed (30 occasions), the assessment of the catheter-tip position differed in 23% of the occasions. When malposition was detected by US, this was detected on routinely performed CXRs in 11% of the occasions.

Conclusions: UVCs often migrate following insertion, often leading to malposition. Awareness for this is needed, and US is a feasible alternative for detecting malposition compared to CXRs and avoids additional radiation. Re-evaluation of the position of UVCs at least once, but within 24 h after placement, is recommended.

Citing Articles

Study draft: "UVC-You Will See" study: longer vs. shorter umbilical venous catheter (UVC) dwell time (6-10 vs. 1-5 days) in very premature infants with birth weight < 1250 g and/or gestational age < 30 weeks.

Meyer S, Hess S, Poryo M, Papan C, Simon A, Welcker S Wien Med Wochenschr. 2024; 174(11-12):217-224.

PMID: 38869762 PMC: 11347460. DOI: 10.1007/s10354-024-01047-7.

Dwell time and bloodstream infection incidence of umbilical venous catheterization in China.

Zheng X, He D, Yang Z, Chen L, Jiang M, Qi Y Pediatr Investig. 2023; 7(4):239-246.

PMID: 38050540 PMC: 10693663. DOI: 10.1002/ped4.12403.

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study.

Xie H, Xie C, Liao J, Xu F, Du B, Zhong B Front Pediatr. 2023; 11:1225087.

PMID: 37691771 PMC: 10483067. DOI: 10.3389/fped.2023.1225087.

The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns.

Barone G, DAndrea V, Ancora G, Cresi F, Maggio L, Capasso A Eur J Pediatr. 2023; 182(8):3385-3395.

PMID: 37195350 DOI: 10.1007/s00431-023-04984-4.

Umbilical venous catheter- and peripherally inserted central catheter-associated complications in preterm infants with birth weight < 1250 g : Results from a survey in Austria and Germany.

Hess S, Poryo M, Bottger R, Franz A, Klotz D, Linnemann K Wien Med Wochenschr. 2022; 173(7-8):161-167.

PMID: 35939216 PMC: 10147741. DOI: 10.1007/s10354-022-00952-z.

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