Central versus Low-Lying Umbilical Venous Catheters: A Multicenter Study of Practices and Complications

Nathalie El Ters; Colleen Claassen; Thomas Lancaster; Alan Barnette; Whitney Eldridge; Flora Yazigi; Komalpreet Brar; Maja Herco; Lauren Rogowski; Marya Strand; Akshaya Vachharajani

doi:10.1055/s-0038-1676482

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2019; 36(11): 1198-1204
DOI: 10.1055/s-0038-1676482

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Central versus Low-Lying Umbilical Venous Catheters: A Multicenter Study of Practices and Complications

Nathalie El Ters

¹Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

,

Colleen Claassen

²Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri

,

Thomas Lancaster

³Sunflower Neonatology Associates, Overland Park, Kansas

,

Alan Barnette

⁴Department of Neonatology, Saint Francis Medical Center, Cape Girardeau, Missouri

,

Whitney Eldridge

¹Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

,

Flora Yazigi

²Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri

,

Komalpreet Brar

²Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri

,

Maja Herco

¹Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

,

Lauren Rogowski

¹Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

,

Marya Strand

²Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri

,

Akshaya Vachharajani

¹Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

› Institutsangaben

Abstract

Objectives Conventional neonatology practice is to place umbilical venous catheters (UVCs) in central position and to limit the use of low-lying catheters. Our objectives were to describe the practices and complications associated with UVCs and to evaluate the type of infusates used with either UVC position.

Study Design A retrospective chart review was performed at four neonatal intensive care units to identify neonates who underwent UVC placement over a 2-year period. Infant demographics, UVC position, catheter days, fluid and medication characteristics, and specific complications were extracted.

Results A total of 2,011 neonates who underwent UVC placement were identified during the 2-year period. Of these, 641 UVCs (31.9%) were identified in the low-lying position. Centrally positioned UVCs were associated with lower gestational age and were left in situ for a longer duration than low-lying UVCs. Infusions of hyperosmolar solutions and vasopressors were significantly higher in central UVCs, though they were used in a significant number of low-lying UVCs. Complications, while not statistically different, were three times higher in low-lying UVCs.

Conclusion Despite conventional teaching, low-lying UVCs were used in nearly one-third of infants in this cohort. Parenteral nutrition, antibiotics, and vasopressors were infused through central and low-lying UVCs. There was no statistically significant difference in complication rates between UVC positions.

Keywords

umbilical venous catheters - central - low-lying - infusates - complications

Volltext

Referenzen

References
1 MacDonald MG. Atlas of Procedures in Neonatology, 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2002
2 Egan II EA, Eitzman DV. Umbilical vessel catheterization. Am J Dis Child 1971; 121 (03) 213-218
3 Green C, Yohannan MD. Umbilical arterial and venous catheters: placement, use, and complications. Neonatal Netw 1998; 17 (06) 23-28
4 Coley BD, Seguin J, Cordero L, Hogan MJ, Rosenberg E, Reber K. Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters. Pediatr Radiol 1998; 28 (12) 923-927
5 Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 2001; 219 (03) 645-650
6 Kurtom W, Quast D, Worley L, Oelberg DG. Incorrect umbilical vein catheterization is associated with severe periventricular hemorrhages and mortality in extremely premature newborns. J Neonatal Perinatal Med 2016; 9 (01) 67-72
7 Lam HS, Li AM, Chu WC, Yeung CK, Fok TF, Ng PC. Mal-positioned umbilical venous catheter causing liver abscess in a preterm infant. Biol Neonate 2005; 88 (01) 54-56
8 Levkoff AH, Macpherson RI. Intrahepatic encystment of umbilical vein catheter infusate. Pediatr Radiol 1990; 20 (05) 360-361
9 Lim-Dunham JE, Vade A, Capitano HN, Muraskas J. Characteristic sonographic findings of hepatic erosion by umbilical vein catheters. J Ultrasound Med 2007; 26 (05) 661-666
10 Nakstad B, Naess PA, de Lange C, Schistad O. Complications of umbilical vein catheterization: neonatal total parenteral nutrition ascites after surgical repair of congenital diaphragmatic hernia. J Pediatr Surg 2002; 37 (08) E21
11 Narang S, Roy J, Stevens TP, Butler-O'Hara M, Mullen CA, D'Angio CT. Risk factors for umbilical venous catheter-associated thrombosis in very low birth weight infants. Pediatr Blood Cancer 2009; 52 (01) 75-79
12 Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002; 110 (1 Pt 1): 137-142
13 Onal EE, Saygili A, Koç E, Türkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe?. Paediatr Anaesth 2004; 14 (11) 953-956
14 Pabalan MJ, Wynn RJ, Reynolds AM. , et al. Pleural effusion with parenteral nutrition solution: an unusual complication of an “appropriately” placed umbilical venous catheter. Am J Perinatol 2007; 24 (10) 581-585
15 Panetta J, Morley C, Betheras R. Ascites in a premature baby due to parenteral nutrition from an umbilical venous catheter. J Paediatr Child Health 2000; 36 (02) 197-198
16 Ramasethu J. Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol 2008; 35 (01) 199-222
17 Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol 2007; 27 (05) 317-319
18 Sherwani P, Vire A, Anand R, Jajoo M. Umbilical venous catheterization gone wrong: Hepatic complications. Indian J Radiol Imaging 2016; 26 (01) 40-43
19 Sinha A, Fernandes CJ, Kim JJ, Fenrich Jr AL, Enciso J. Atrial flutter following placement of an umbilical venous catheter. Am J Perinatol 2005; 22 (05) 275-277
20 Thomson TL, Levine M, Muraskas JK, El-Zein C. Pericardial effusion in a preterm infant resulting from umbilical venous catheter placement. Pediatr Cardiol 2010; 31 (02) 287-290
21 Traen M, Schepens E, Laroche S, van Overmeire B. Cardiac tamponade and pericardial effusion due to venous umbilical catheterization. Acta Paediatr 2005; 94 (05) 626-628
22 Unal S, Arifoglu I, Celik IH, Yilmaz O, Bas AY, Demirel N. Pleural and pericardiac effusion as a complication of properly placed umbilical venous catheter. J Neonatal Surg 2017; 6 (02) 34
23 Van Niekerk M, Kalis NN, Van der Merwe PL. Cardiac tamponade following umbilical vein catheterisation in a neonate. S Afr Med J 1998; 88 (Suppl 2): C87-C90
24 Verheij G, Smits-Wintjens V, Rozendaal L, Blom N, Walther F, Lopriore E. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates. BMJ Case Rep 2009; 2009: bcr04.2009.1778
25 Hagerott HE, Kulkarni S, Restrepo R, Reeves-Garcia J. Clinical-radiologic features and treatment of hepatic lesions caused by inadvertent infusion of parenteral nutrition in liver parenchyma due to malposition of umbilical vein catheters. Pediatr Radiol 2014; 44 (07) 810-815
26 Abiramalatha T, Kumar M, Shabeer MP, Thomas N. Advantages of being diligent: lessons learnt from umbilical venous catheterisation in neonates. BMJ Case Rep 2016; 2016: bcr2015214073
27 Al Nemri AM, Ignacio LC, Al Zamil FA, Al Jarallah AS. Rare but fatal complication of umbilical venous catheterization. Congenit Heart Dis 2006; 1 (04) 180-183
28 Atmawidjaja RW, Azri M, Ismail IH. Cardiac tamponade: a rare but preventable complication of central venous catheter in neonates. Med J Malaysia 2016; 71 (03) 147-148
29 Chang PT, Taylor GA. Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia. Pediatr Radiol 2015; 45 (07) 982-988
30 Dubbink-Verheij GH, Bekker V, Pelsma ICM. , et al. Bloodstream infection incidence of different central venous catheters in neonates: a descriptive cohort study. Front Pediatr 2017; 5: 142
31 Egyepong J, Jain A, Chow P, Godambe S. Parenteral nutrition--ascites with acute renal failure as a complication from an umbilical venous catheter in an extremely low birth weight infant. BMJ Case Rep 2011; 2011: bcr0220113813
32 Franta J, Harabor A, Soraisham AS. Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study. Arch Dis Child Fetal Neonatal Ed 2017; 102 (03) F251-F255
33 Garg M, Chang CC, Merritt RJ. An unusual case presentation: pericardial tamponade complicating central venous catheter. J Perinatol 1989; 9 (04) 456-457
34 Grizelj R, Vukovic J, Bojanic K. , et al. Severe liver injury while using umbilical venous catheter: case series and literature review. Am J Perinatol 2014; 31 (11) 965-974
35 Hermansen MC, Hermansen MG. Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol 2005; 32 (01) 141-156 , vii
36 Landers S, Moise AA, Fraley JK, Smith EO, Baker CJ. Factors associated with umbilical catheter-related sepsis in neonates. Am J Dis Child 1991; 145 (06) 675-680
37 Loisel DB, Smith MM, MacDonald MG, Martin GR. Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. J Perinatol 1996; 16 (06) 461-466
38 Orme RM, McSwiney MM, Chamberlain-Webber RF. Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: a case report and review of the literature. Br J Anaesth 2007; 99 (03) 384-388
39 Raisanen P, Cassel I, Martin G, Graziano K. Umbilical venous catheter complication in an infant with left-sided congenital diaphragmatic hernia: extravasation owing to hepatic vein catheterization. J Pediatr Surg 2010; 45 (12) e33-e35
40 Shalabi M, Adel M, Yoon E, Aziz K, Lee S, Shah PS. ; Canadian Neonatal Network Risk of infection using peripherally inserted central and umbilical catheters in preterm neonates. Pediatrics 2015; 136 (06) 1073-1079
41 Shareena I, Khu YS, Cheah FC. Intraperitoneal extravasation of total parental nutrition infusate from an umbilical venous catheter. Singapore Med J 2008; 49 (02) e35-e36
42 Poonai N, Kornecki A, Buffo I, Pepelassis D. Neonatal myocardial infarction secondary to umbilical venous catheterization: a case report and review of the literature. Paediatr Child Health 2009; 14 (08) 539-541
43 Sulemanji M, Vakili K, Zurakowski D, Tworetzky W, Fishman SJ, Kim HB. Umbilical venous catheter malposition is associated with necrotizing enterocolitis in premature infants. Neonatology 2017; 111 (04) 337-343
44 Davies MW, Cartwright DW. Insertion of umbilical venous catheters past the ductus venosus using the double catheter technique. Arch Dis Child Fetal Neonatal Ed 1998; 78 (03) F234
45 Ohki Y, Maruyama K, Harigaya A, Kohno M, Arakawa H. Complications of peripherally inserted central venous catheter in Japanese neonatal intensive care units. Pediatr Int 2013; 55 (02) 185-189
46 Lausten-Thomsen U, Merchaoui Z, Dubois C. , et al. Ultrasound-guided subclavian vein cannulation in low birth weight neonates. Pediatr Crit Care Med 2017; 18 (02) 172-175