scholarly journals 38 Does Umbilical Venous Catheter tip position impact complication rates in neonates?

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e15-e15
Author(s):  
Sunil Joghee
Keyword(s):  
Cardiac Arrhythmias ◽  
Venous Catheter ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Optimal Position ◽  
High Position ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Late Insertion

Abstract Background Umbilical venous catheter (UVC) insertion is a very common procedure in neonatal intensive care units (NICU). UVCs are placed in ideal position in only about 50% cases. It is common practice to secure UVC in low position in the event of failure to place in optimal position. However, little is known about the association between catheter tip position and UVC related complications in neonates. Objectives The primary objective was to examine the association between the UVC tip position and UVC related complications in neonates. Our secondary objective was to evaluate the association between timing of UVC insertion and complication rates. Design/Methods We performed a retrospective cohort study of all neonates who had UVC inserted in a tertiary NICU between January 2017 and December 2018. Neonates with major congenital or chromosomal anomalies, hydrops fetalis and prenatally diagnosed cardiac arrhythmias or pericardial effusion were excluded. Electronic medical records and medical charts were reviewed. The primary outcome was presence of any one of the following complications: cardiac (arrhythmias, pericardial effusion, intracardiac thrombosis), hepatic (liver hematoma, cystic fluid collection in the liver, liver abscess, portal vein thrombosis), catheter associated infection, and mechanical complications. We compared the complications rates based on UVC tip position as determined by thoraco-abdominal radiograph. Optimal UVC position was defined as catheter tip between T8-T10 vertebral levels; low position as below T10 and high position as above T8. We also examined the association between time at UVC insertion (i.e. early (<12 hours) versus late (≥12 hours) and the type of complications. Results Among the 589 neonates who had UVC inserted during the study period, 40 were excluded. Of 549 included, UVC tip was at optimal position in 267 (48.6%), low position in 248 (45.2%) and high position in 34 (6.2%) neonates. The mean gestational age and birth weight of the study cohort were 30.9 ± 5.1 weeks and 1712 ± 1035g respectively. The mean birth weight and gestational age were comparable among the three groups. The overall complication rate was 36/549 (6.5%). There were no significant differences in the overall complication rates between the three groups (Table 1). However, cardiac complications (arrhythmias) were more frequent in the high UVC group compared to the optimum position group (8.8% vs 0.37%, OR 10; 95% CI 1.84, 56.5). Among 549 neonates, 391 had early UVC insertion and 158 had late insertion of UVC. There was no significant difference in UVC related complications between early and late insertion of UVC (6.9 % versus 5.7%, OR 2.49; 95% CI 0.34, 17.8). Conclusion The UVC related complications were more frequent in infants with high UVC position and least among those with optimal UVC position; although not statistically significant, it may be clinically important. High UVC position was more frequently associated with cardiac complications. There was no difference in complication rates between early and late UVC insertion.

Accuracy of five formulae to determine the insertion length of umbilical venous catheters

2018 ◽  
Vol 104 (2) ◽  
pp. F165-F169 ◽  
Author(s):  
Wei Ling Lean ◽  
Jennifer A Dawson ◽  
Peter G Davis ◽  
Christiane Theda ◽  
Marta Thio
Keyword(s):  
Gold Standard ◽  
Prospective Observational Study ◽  
Venous Catheter ◽  
X Rays ◽  
X Ray ◽  
High Position ◽  
Catheter Tip ◽  
Precision And Accuracy ◽  
Tip Position ◽  
Insertion Length

IntroductionUmbilical venous catheter (UVC) placement is a common neonatal procedure. It is important to position the UVC tip accurately at the first attempt to prevent complications and minimise handling. Catheters positioned too low need to be removed, but catheters positioned too high may be withdrawn in a sterile fashion to a safe position. We aimed to determine the precision and accuracy of five published formulae developed to guide UVC placement.MethodsThis was a prospective observational study. Following UVC insertion, anteroposterior and lateral X-rays were performed to identify catheter tip position. Parameters required to apply the five formulae were recorded. Insertion lengths were then calculated and compared with the gold standard (UVC tip at the level of the diaphragm on the lateral X-ray). They were also used to classify predicted UVC tip position as either correct (UVC tip at or up to 1 cm above the diaphragm), too high or too low.ResultsOf 118 eligible infants, 70 had the UVC tip in a position where measurements could be used. Their median (IQR) gestational age and weight were 28.5 (26–36) weeks and 1035 (745–2788) g, respectively. The predicted success rate for each formula ranged from 44.9% to 55.7%. A formula based on birth weight had the highest rate of either correct or high position (95.8%).ConclusionsInserting a UVC into a safe position on first attempt is difficult and low tip placement is common. Around half of UVCs need to be manipulated to achieve the desired position.

Precision in Central Venous Catheter Tip Placement: A Review of the Literature

2010 ◽  
Vol 15 (3) ◽  
pp. 112-125 ◽  
Author(s):  
Russell Hostetter ◽  
Nadine Nakasawa ◽  
Kim Tompkins ◽  
Bradley Hill
Keyword(s):  
Central Venous Catheter ◽  
Selection Criteria ◽  
Weighted Average ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Landmark Technique ◽  
The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

2020 ◽  
Vol 21 (5) ◽  
pp. 732-737
Author(s):  
Chunli Liu ◽  
Dingbiao Jiang ◽  
Tao Jin ◽  
Chuanyin Chen ◽  
Ruchun Shi ◽  
...  
Keyword(s):  
Upright Position ◽  
Body Posture ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Posture Change ◽  
Body Change ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Chinese Cancer Patients

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p = 0.009) and height ( p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation

2018 ◽  
Vol 19 (6) ◽  
pp. 528-534 ◽  
Author(s):  
Folkert Steinhagen ◽  
Maximilian Kanthak ◽  
Guido Kukuk ◽  
Christian Bode ◽  
Andreas Hoeft ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
The Right

Introduction: A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. Methods: An observational prospective case–control cohort study was set up to study the feasibility and accuracy of the electrocardiography-controlled central venous catheter tip placement in 13 patients with atrial fibrillation versus 10 patients with sinus rhythm scheduled for elective surgery. Each intervention was crosschecked with ultrasound-guided positioning via right supraclavicular fossa view and chest radiography. Ultrasound-guided supraclavicular venipuncture of the right subclavian vein and guidewire advancement were performed. A B-mode view of the superior vena cava and the right pulmonary artery was obtained to visualize the J-tip of the guidewire. The central venous catheter was advanced over the guidewire and the electrocardiography was derived from the J-tip of the guidewire protruding from the central venous catheter tip. Electrocardiography was read for increased p- and atrial fibrillation waves, respectively, and insertion depth was compared with the ultrasound method. Results: Electrocardiography indicated significantly increasing fibrillation and p-waves, respectively, in all patients and ultrasound-guided central venous catheter positioning confirmed a tip position within the lower third of the superior vena cava. Conclusion: Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure.

scholarly journals Optimal position of a long-term central venous catheter tip in a pediatric patient with congenital diseases

2012 ◽  
Vol 4 (3) ◽  
pp. 32 ◽  
Author(s):  
Marco Caruselli ◽  
Dario Galante ◽  
Anna Ficcadenti ◽  
Laura Carboni ◽  
Federica Franco ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
High Frequency ◽  
Young Patients ◽  
Venous Catheter ◽  
Central Venous ◽  
Optimal Position ◽  
Congenital Diseases ◽  
The Past ◽  
Catheter Tip

Progress in medical and scientific research has increased the chances of survival for young patients with congenital diseases, children who, in the past, would not have had any chance of survival. Nowadays, congenital diseases can be treated with appropriate replacement therapies. These treatments can be difficult to administer in young patients because of the high frequency of administration (sometimes more than a dose per week), the use of intravenous infusion and the long-term or life-term requirement.

Impact of Phase of Respiration on Central Venous Catheter Tip Position

2013 ◽  
Vol 14 (4) ◽  
pp. 383-387 ◽  
Author(s):  
Patrick P. Pan ◽  
Bjorn I. Engstrom ◽  
Matthew P. Lungren ◽  
Danielle M. Seaman ◽  
Mark L. Lessne ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position

1320: IS IT REALLY A MALPOSITION? THE CENTRAL VENOUS CATHETER TIP POSITION CONTROVERSY CONTINUES

2020 ◽  
Vol 48 (1) ◽  
pp. 637-637
Author(s):  
Enyo Ablordeppey ◽  
Rebecca Doctor ◽  
Brett Wakefield ◽  
Valerie Lew ◽  
Anne Drewry ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position

Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography

2018 ◽  
Vol 19 (5) ◽  
pp. 461-466 ◽  
Author(s):  
Manuel F Struck ◽  
Sebastian Ewens ◽  
Wolfram Schummer ◽  
Thilo Busch ◽  
Michael Bernhard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Central Venous Catheter ◽  
Injury Severity ◽  
Venous Catheter ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Multiple Trauma Patients

Purpose: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. Methods: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°. Results: During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure <90 mmHg) at admission (58.6% vs 33.8%, p = 0.023) and a higher mean injury severity score (38.5 ± 15.7 vs 31.6 ± 11.8, p = 0.041) compared with patients with correctly positioned central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005–1.074, p = 0.024). Conclusion: Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.

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