Complications Associated with Low Position versus Good Position Umbilical Venous Catheters in Neonates of ≤32 Weeks' Gestation

Abstract

Objective This study aimed to determine the incidence of umbilical venous catheter associated infection (UVCAI) in very preterm infants based on UVC tip position.

Study Design In this retrospective cohort study, infants born at ≤32 weeks were divided into groups with a UVC tip in either a low-lying or good position. The primary outcome was UVCAI. Survival analysis represented time to infection between groups. Subgroup analyses were based on duration of UVC indwelling time.

Results Of 1,983 infants, 1,638 infants were eligible; 33% had low-lying UVC and 67% had good position UVC. Survival analyses suggested a significantly higher probability of infection was associated with low UVC (adjusted hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.1–3.2; p = 0.001). The risk of infection was higher for UVC of >7 days duration (adjusted HR: 2.2, 95% CI: 1.1–4.2). Extravasation as a complication was significantly higher in the low UVC versus good position UVC (1.3 vs. 0.1%; odds ratio: 14.4, 95% CI: 1.8–119).

Conclusion Low-lying UVC was associated with higher risk of infection and extravasation.

Key Points

• Low-lying UVC are at higher risk of UVCAI.

• Presence of UVC in situ for > 7 days carries higher risk of UVCAI.

• There was a higher risk of UVC extravasation with low UVCs.

Keywords

umbilical - catheter-related infections - prevention and control - infant - newborn

Authors' Contributions

M.S. developed the study protocol, data collection sheet, initial manuscript and approved the final manuscript as submitted. A.M.M. collected data. P.S.S. reviewed and edited the study protocol and manuscript and approved the final manuscript as submitted. J.Y. reviewed the collected data and did the statistical analysis and approved the final manuscript as submitted. A.M. conceived the idea, reviewed and edited the study protocol, supervised study analyses, reviewed, edited and approved the final manuscript as submitted. R.Y. reviewed and edited the manuscript and approved the final manuscript as submitted.

Note

Ethical approval was obtained from the Research Ethics Board of Mount Sinai Hospital, Toronto, Ontario, Canada.

Publication History

Received: 03 April 2020

Accepted: 29 June 2020

Article published online:
09 August 2020

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