Ultrasound-Guided Umbilical Venous Catheter Insertion to Reduce Rate of Catheter Tip Malposition in Neonates: A Randomized, Controlled Trial: Authors’ Reply

Abstract

References1. Yadav A, Meena J, Kumar J. Ultrasound-guided umbilical venous catheter insertion to reduce rate of catheter tip malposition in neonates: a randomized, controlled trial: correspondence. Indian J Pediatr. 2022.

Does the use of point of care ultrasound (POCUS) improve umbilical venous catheter (UVC) positioning in neonates?

“…Four of the six studies we identified illustrated a decrease in the occurrence of malpositioned or suboptimally positioned UVC tips when US was employed 1 3–5. This reduction ranged from 11.8% to 44.3%.…”

“…Following screening of 62 titles and abstracts, 26 studies were reviewed in full, and 6 studies were included in this evidence review (table 1 and online supplemental table). 1–6…”

“…Traditionally, the catheter tip position is assessed by the anteroposterior (AP) thoracoabdominal radiography and possibly lateral radiographs for situations where catheter position cannot be determined with a single view 1 2. Radiographs rely on surrogate or anatomical markers such as the cardiac silhouette, vertebral bodies or diaphragm to assess tip position, without the direct visualisation of the UVC tip within anatomical structures 3.…”

“…Recent evidence suggests that US has better sensitivity and specificity, greater positive predictive value and negative predictive value in identifying the tip of central catheters compared with radiography 3 8. US also allows for the immediate manipulation of the line at the time of insertion, minimising catheter malposition 1 4. In the absence of US guidance, suboptimal placement of UVCs necessitates numerous adjustments and additional X-rays, leading to excessive handling of critically ill infants, heightened radiation exposure and increased time consumption 2.…”

“…This reduction ranged from 11.8% to 44.3%. Demonstrating a 43% reduction in unsatisfactory tip position in the US group in comparison to the standard (X-ray) group, Kaur et al also revealed a 41% lower rate of malposition among very low birth weight (VLBW) neonates (p=0.033) 1. Through early identification of the catheter tip in the portal vein, investigators were able to manipulate the catheter through the ductus venosus (DV) in 8 out of 15 neonates 1.…”