PDF herunterladen
Am J Perinatol 2022; 39(16): 1805-1811
DOI: 10.1055/s-0041-1726385
Original Article

Factors Associated with Umbilical Venous Catheter Malposition in Newborns: A Tertiary Center Experience

Sasivimon Soonsawad
1   Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
3   Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
,
Emily A. Kieran
1   Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
,
Joseph Y. Ting
1   Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
2   BC Children's Hospital Research Institute, Vancouver, BC, Canada
,
Esther AlonsoPrieto
1   Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
2   BC Children's Hospital Research Institute, Vancouver, BC, Canada
,
Julia K. Panczuk
1   Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada
› Institutsangaben Funding J.T. received investigator grant award from the British Columbia Children's Hospital Research Institute, which has no role in the design and conduct of the study, preparation, and decision to submit the manuscript for publication.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective Umbilical venous catheters (UVC) are widely used in neonatal intensive care (NICU). Noncentral catheter position is known to be associated with multiple adverse complications; however, risk factors for catheter malposition are unclear. This work aimed to identify clinical risk factors and complications associated with UVC malposition in neonates admitted in an NICU.

Study Design A retrospective chart review was performed of inborn babies admitted to BC Women's Hospital NICU with UVC inserted in their first 7 days between July 2016 and June 2018. Infant and maternal demographic, radiograph, UVC-related data, and complications were reviewed.

Results A total of 257 infants had UVC placed; 158 (61%) and 99 (39%) were in central and noncentral positions after initial placement, respectively. Of initially central-placed UVCs, a further 35 (22%) were pulled back or migrated to malposition on follow-up X-ray. Multivariable logistic regression analysis revealed the use of larger UV (5 Fr) catheter (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.1–5.6, p = 0.026) and escalation of respiratory support mode (OR: 1.7, 95% CI: 1.0–2.8, p = 0.049) as significant predictors of catheter malposition.

Conclusion Noncentral UVC position as well as migration were common after initial placement in this cohort. The use of larger size UV catheters and increasingly invasive respiratory support were risk factors associated with higher incidence of UVC malposition. Ongoing surveillance of UVC position is thus recommended.

Key Points

  • More than one-third of UV catheters were not in central position after the initial placement.

  • Large size UV catheters and increasingly invasive respiratory support were risk factors for UV malposition.

  • High incidence of UVC migration was found after initial central placement, warranting surveillance.

Keywords

umbilical venous catheter - newborn - malposition - risk factors


Publikationsverlauf

Eingereicht: 30. Oktober 2020

Angenommen: 10. Februar 2021

Artikel online veröffentlicht:
14. April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • Reference

  • 1 Shahid S, Dutta S, Symington A, Shivananda S. McMaster University NICU. Standardizing umbilical catheter usage in preterm infants. Pediatrics 2014; 133 (06) e1742-e1752
    CrossrefPubMedGoogle Scholar
  • 2 Tsui BCH, Richards GJ, Van Aerde J. Umbilical vein catheterization under electrocardiogram guidance. Paediatr Anaesth 2005; 15 (04) 297-300
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Amer A, Broadbent RS, Edmonds L, Wheeler BJ. Central venous catheter-related tachycardia in the newborn: case report and literature review. Case Rep Med 2016; 2016: 6206
    CrossrefPubMedGoogle Scholar
  • 5 Abiramalatha T, Kumar M, Shabeer MP. Pleural effusion caused by a malpositioned umbilical venous catheter in a neonate. BMJ Case Rep 2015; 2015: 1-4
    PubMedGoogle Scholar
  • 6 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: 1-6
    PubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Bayhan C, Takcı Ş, Ciftçi TT, Yurdakök M. Sterile hepatic abscess due to umbilical venous catheterization. Turk J Pediatr 2012; 54 (06) 671-673
    PubMedGoogle Scholar
  • 10 Mutlu M, Aslan Y, Kul S, Yılmaz G. Umbilical venous catheter complications in newborns: a 6-year single-center experience. J Matern Fetal Neonatal Med 2016; 29 (17) 2817-2822
    CrossrefPubMedGoogle Scholar
  • 11 Plooij-Lusthusz AM, van Vreeswijk N, van Stuijvenberg M, Bos AF, Kooi EMW. Migration of umbilical venous catheters. Am J Perinatol 2019; 36 (13) 1377-1381
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 Verheij GH, te Pas AB, Smits-Wintjens VEHJ, Šràmek A, Walther FJ, Lopriore E. Revised formula to determine the insertion length of umbilical vein catheters. Eur J Pediatr 2013; 172 (08) 1011-1015
    CrossrefPubMedGoogle Scholar
  • 14 Haase R, Hein M, Thäle V, Vilser C, Merkel N. (Umbilical venous catheters - analysis of malpositioning over a 10-year period). Z Geburtshilfe Neonatol 2011; 215 (01) 18-22
    PubMedGoogle Scholar
  • 15 Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child 1966; 41 (215) 69-75
    CrossrefPubMedGoogle Scholar
  • 16 Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child 1986; 140 (08) 786-788
    PubMedGoogle Scholar
  • 17 Kieran EA, Laffan EE, O'Donnell CPF. Estimating umbilical catheter insertion depth in newborns using weight or body measurement: a randomised trial. Arch Dis Child Fetal Neonatal Ed 2016; 101 (01) F10-F15
    CrossrefPubMedGoogle Scholar
  • 18 Sharma D, Farahbakhsh N, Tabatabaii SA. Role of ultrasound for central catheter tip localization in neonates: a review of the current evidence. J Matern Fetal Neonatal Med 2019; 32 (14) 2429-2437
    CrossrefPubMedGoogle Scholar
  • 19 Oestreich AE. Umbilical vein catheterization--appropriate and inappropriate placement. Pediatr Radiol 2010; 40 (12) 1941-1949
    CrossrefPubMedGoogle Scholar
  • 20 El Ters N, Claassen C, Lancaster T. et al. Central vs. low-lying umbilical venous catheters: a multicenter study of practices and complications. Am J Perinatol 2019; 36 (11) 1198-1204
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 21 The Canadian Neonatal Network™ Leréseau Neonatal Canadian™ Abstractor's Manual. Accessed 2021 at. https://www.canadianneonatalnetwork.org/Portal/LinkClick.aspx?fileticket=cTxhYqb72PQ%3D&tabid=69
    PubMedGoogle Scholar
  • 22 Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17 (04) 213-288
    PubMedGoogle Scholar
  • 23 CDC - Center for Disease Control and Prevention, Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection), Centers for Disease Control (CDC)/National Healthcare Safety Network (NHSN). Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection. Accessed January 2021 at: http://www.cdc.gov/nhsn/PDFs/pscM 2016
    PubMedGoogle Scholar
  • 24 Gohil B, Balasubramanian H, Kabra NS, Ahmed J, Dash S, Raval G. Malposition rate with varying umbilical vein catheter sizes in VLBW neonates: a randomized controlled trial. Perinatology 2020; 21 (01) 7-14
    PubMedGoogle Scholar
  • 25 Kiserud T. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 1999; 84 (02) 139-147
    CrossrefPubMedGoogle Scholar
  • 26 Young A, Harrison K, Sellwood MW. How to use… Imaging for umbilical venous catheter placement. Arch Dis Child Educ Pract Ed 2019; 104 (02) 88-96
    CrossrefPubMedGoogle Scholar
  • 27 Soni N, Williams P. Positive pressure ventilation: what is the real cost?. Br J Anaesth 2008; 101 (04) 446-457
    CrossrefPubMedGoogle Scholar
  • 28 Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics. 2002; 110 (1 I): 137-142
    PubMedGoogle Scholar
  • 29 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 30 Dubbink-Verheij GH, Visser R, Roest AA, Van Ommen CH, Te Pas AB, Lopriore E. Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound. Arch Dis Child Fetal Neonatal Ed 2020; 105 (03) 299-303
    CrossrefPubMedGoogle Scholar
  • 31 O'Grady NP, Alexander M, Dellinger EP. et al; Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002; 51 (RR-10(: 1-29
    PubMedGoogle Scholar
  • 32 Guimarães AFM, Souza AA, Bouzada MCF, Meira ZMA. Accuracy of chest radiography for positioning of the umbilical venous catheter. J Pediatr (Rio J) 2017; 93 (02) 172-178
    CrossrefPubMedGoogle Scholar