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 Catheters positioned too low need to be removed, but catheters positioned too high may be withdrawn in a sterile fashion to a safe position.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.

Accuracy of chest radiography compared to ultrasound for positioning the umbilical venous catheter in neonates: A meta-analysis and systematic review

2021 ◽  
pp. 112972982110467
Author(s):  
Juan Cao ◽  
Yuzheng Zhang ◽  
Yanling Yin ◽  
Yuxiu Liu
Keyword(s):  
Chest Radiography ◽  
Gold Standard ◽  
Data Extraction ◽  
Meta Analysis ◽  
Venous Catheter ◽  
Cochrane Library ◽  
Anatomical Location ◽  
Original Design ◽  
X Ray ◽  
Tip Position

This study was aimed to investigate the accuracy of anteroposterior chest radiography for tip position verification for the umbilical venous catheters in neonates compared to ultrasound. A search in the PubMed, Embase, the Cochrane Library, and EBSCO was conducted to evaluate all the related articles on umbilical venous catheter (UVC), ultrasound AND neonates updated to August, 2020. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random effects model was used to estimate the pooled sensitivity, specificity, and diagnostic odds ratio (DOR). The summary receiver operator characteristic (SROC) curve was constructed, and the area under the SROC curve (AUC) was calculated. Fourteen related studies were finally included for meta-analysis. The overall diagnostic sensitivity and specificity of X-ray on tip verification of UVC were 0.90 (95% CI 0.71–0.97) and 0.82 (95% CI 0.53–0.95), respectively. The pooled DOR was 3.69 (95% CI 1.64–5.71). The AUC was 0.93 (95% CI 0.90–0.95). The meta-regression analysis suggested that study sample size, study design, different US confirming method, and different gold standard in original design might be potential sources of heterogeneity. Our conclusion is that the commonly used anteroposterior X-ray is not reliable in identifying the exact anatomical location of UVC tip in neonates. Studies suggested ultrasound or echocardiography with saline contrast injection could be the gold standard for verification of catheter location and should be considered whenever possible, especially in premature patients. More studies are needed to expand the use of ultrasound or echocardiography in tip position confirming of UVCs.

Intra- and Inter-Rater Agreement between X-Ray Views for Umbilical Catheter Position

2019 ◽  
Author(s):  
Srinivasa Murthy Doreswamy ◽  
Sumesh Thomas ◽  
Sourabh Dutta
Keyword(s):  
Random Sequence ◽  
Venous Catheter ◽  
Rater Agreement ◽  
Catheter Position ◽  
X Ray ◽  
Umbilical Catheter ◽  
Catheter Tip ◽  
Tip Position ◽  
Umbilical Arterial Catheter

Abstract Objective We determined intra- and inter-rater agreement for umbilical arterial/venous catheter (umbilical arterial catheter [UAC] and umbilical venous catheter [UVC], respectively) positions on supine anteroposterior (AP) and horizontal dorsal decubitus (HDD) X-ray views to determine whether two views are routinely required. Study Design This retrospective study was conducted in McMaster University, Canada. Pairs of AP and HDD radiographs were coded and rated in random sequence by two experienced raters. Primary outcome was intra-rater agreement (κ) between AP and HDD views for UVC catheter tip position. Secondary outcomes included inter-rater κ for UVC position; inter- and intra-rater κ for UAC position, inter- and intra-rater κ for follow-up action. To detect κ of 0.8 (width of 95% confidence interval = 0.1), 138 radiograph pairs were required. Results Intra-rater agreement tended to be higher for UVC versus UAC position (Rater#1: κ = 0.44 vs. 0.16, respectively, p = 0.08; and #2: κ = 0.56 vs. 0.47, respectively, p = 0.5). Inter-rater agreement was higher on AP versus HDD view for UVC position (κ = 0.6 vs. 0.29, respectively, p = 0.03) and action recommended for UVC (κ = 0.61 and 0.19, respectively, p < 0.001). Conclusion AP is superior to HDD view for UVC.

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 (&lt;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.

ASSESSMENT OF OSTEOARTHRITIS INITIATIVE–KELLGREN AND LAWRENCE SCORING PROJECTS QUALITY USING COMPUTER ANALYSIS

2010 ◽  
Vol 13 (04) ◽  
pp. 197-201 ◽  
Author(s):  
Lior Shamir ◽  
David T. Felson ◽  
Luigi Ferrucci ◽  
Ilya G. Goldberg
Keyword(s):  
Image Analysis ◽  
Gold Standard ◽  
Population Studies ◽  
Detection Accuracy ◽  
X Rays ◽  
Analysis Method ◽  
Image Analysis Method ◽  
X Ray ◽  
Osteoarthritis Initiative ◽  
Kellgren And Lawrence

The detection of knee osteoarthritis (OA) is a subjective task, and even two highly experienced and well-trained readers might not always agree on a specific case. This problem is noticeable in OA population studies, in which different scoring projects provide significantly different scores for the same knee X-rays. Here we propose a method for quantitative assessment and comparison of knee X-ray scoring projects in OA population studies. The method works by applying an image analysis method that automatically detects OA in knee X-ray images, and comparing the consistency of the scores when using each of the scoring projects as "gold standard." The method was applied to compare the osteoarthritis initiative (OAI) clinic reading derived Kellgren and Lawrence (K&L) scores to central reading, and showed that when using the derived K&L scores the automatic image analysis method was able to accurately differentiate between healthy joints and moderate OA joints in ~70% of the cases. When the OAI central reading scores were used as gold standard, the detection accuracy was elevated to ~77%. These results show that the OAI central readings scores are more consistent with the X-rays, indicating that the central reading better reflects the radiographic features associated with OA, compared to the OAI K&L scores derived from clinic readings.

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%.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document