Determination of Umbilical Venous Catheter Tip Position With Radiograph

Hoellering, Adam; Koorts, Pieter; Cartwright, David; Davies, Mark W

doi:10.1097/pcc.0b013e31829f5efa

Cited by 52 publications

(60 citation statements)

References 15 publications

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“…In only 1/40 infants we could not visualize the UVC tip by US. To improve the detection of migration and malposition of UVCs, US is a valuable and feasible tool, as it mostly takes only a few minutes and avoids additional exposure to radiation [17, 24]. Our study showed that inadvertent migration occurs frequently between the placement of the UVC and Day 3.…”

Section: Discussionmentioning

confidence: 80%

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Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 80%

“…Migration of UVCs has been reported anecdotally [15-17]. Case reports described UVC-related complications such as pericardial effusion, left atrial thrombosis, and intrahepatic hematoma in infants with a migrated UVC at the time of detection of the complication [15, 16].…”

Section: Discussionmentioning

confidence: 99%

Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

et al. 2019

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“…Umbilikal venöz kateter ucu ideal olarak vena kava inferiorun suprahepatik segmentinde ya da atriokaval bileşke düzeyinde sonlanmalıdır (3,4,6). Direkt radyografide bu düzey inspiryum ya da ekspiryuma göre değişebilmekle birlikte, yaklaşık T8-T10 vertebralar arası olarak bildirilmektedir (2,3,6,10). Ancak preterm bebeklerin vücut ağırlıkları küçük olduğundan, direkt radyografide bir vertebra boyu kadar bir fark dahi UVK malpozisyonuna bağlı komplikasyon gelişimine neden olabilir.…”

Section: Gereç Ve Yöntemlerunclassified

“…Bu düzey direkt radyografide sağ hemidiyafragma düzeyi olarak değerlendirilebilir. Kateter ucunun birçok yayında T8-T10 vertebra düzeyleri arasında olması gerektiği bildirilmiştir (3,6,(8)(9)(10). Kateter fazla ilerletilirse ucu kalpte sonlanırken, az ilerletilirse ucu karaciğer içerisinde kalır ve her iki durumda da çeşitli komplikasyonlara neden olabilir.…”

Section: Introductionunclassified

Comparison of Direct Radiography and Ultrasonography for the Evaluation of the Umbilical Venous Catheter Position

Derinkuyu¹,

Zencıroğlu²

2017

Turkish J Pediatr Dis

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ÖzETAmaç: Çalışmada umbilikal venöz kateter pozisyonunun belirlenmesinde rutin olarak kullanılan direkt radyografi ile radyasyon içermeyen bir yöntem olan ultrasonografinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler:Mart-Temmuz 2016 tarihleri arasında umbilikal venöz kateter takılmış ve kateter takılı iken, farklı nedenlerle abdominal ultrasonografi yapılmış 20 bebeğin ultrasonografi ve direkt radyografi incelemeleri retrospektif olarak değerlendirilmiştir. Kateter seyri ve ucunun sonlanma düzeyi her iki teknikle ayrı ayrı incelenmiştir.Bulgular: Direkt grafide torakal vertebralar temel alındığında, kateter uçlarının %60'ı T8-T10 aralığında sonlanmakta iken, %40'I T11-T12 düzeyleri arasında inferior konumluydu ve karaciğer içerisindeki vasküler yapılarda sonlanmaktaydı. Direkt grafide sağ hemidiyafragma seviyesi temel alındığında, kateter uçları hastaların %65'inde sağ hemidiyafragmanın altında iken, %35'inde sağ hemidiyafragma düzeyinde sonlanmaktaydı. Ultrasonografi bulgularına göre kateterlerin %30'i suprahepatik inferior vena kavada, geriye kalan %70'i karaciğer içerisinde bir vasküler yapıda sonlanmaktaydı. Ayrıca, ultrasonografi ile iki olguda sol portal ven trombozu ve bir olguda karaciğerde parankimal hematom olmak üzere toplam üç hastada kateter ile ilişkili komplikasyon saptandı. Sonuç:Ultrasonografi umbilikal venöz kateterlerin seyri ve uçlarının anatomik sonlanma noktalarını net olarak ortaya koyabilmekte, komplikasyonları saptamada daha üstün görülmektedir. Bu nedenle radyografiye alternatif bir teknik olup yenidoğan yoğun bakım ünitelerinde yaygın olarak kullanılabilir.Anahtar Sözcükler: Umbilikal venöz kateter, Ultrasonografi, Radyografi, Yenidoğan ABSTrAcT Objective: To determine the umbilical venous catheter position by ultrasound and radiography, and to compare these two techniques. Material and Methods:We retrospectively evaluated the abdominal ultrasound and direct radiography of 20 umbilical venous catheters placed in neonates between March and July 2016. The location of the catheter tips was noted in both techniques.results: According to direct radiography, the tips of the catheters terminated at the T8-T10 level in 60% of the cases. Whereas, in the remaining 40% of the cases, the tips of the catheters terminated inferiorly at the T11-T12 level. When we consider the tip of the catheter according to the level of right hemidiaphragm on the radiograph, the catheter tips of 35% of the cases terminated at the level of the right hemidiaphragm, while 65% were below the level of the right hemidiaphragm. On ultrasound, the tips of the catheters terminated at the suprahepatic inferior vena cava in 30% of the cases, whereas, the remaining 70% terminated inferiorly and were located in the liver. Furthermore, ultrasound revealed catheter complications in three cases. Conclusion:Ultrasonography seems a reliable technique for the determination of the umbilical venous catheter tip and its position and may be an alternative to direct radiography.

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“…Anteroposterior (AP) and lateral X-rays are commonly used to determine the position of the catheter tip5 6 and to interpret where the cavoatrial junction is 7. When the UVC tip sits too high, the catheter can be withdrawn to a safe position while the operator maintains sterility.…”

Section: Introductionmentioning

confidence: 99%