The Ductus Venosus

Background the ductus venosus (DV) is not well known in general radiology, but it plays a role in the daily work of pediatric radiologists. Consequently all general radiologists who also care for a pediatric department should be familiar with the physiological and pathological findings related to the DV. Methods: Literature research in Medline, using the keywords “ductus venosus” and “umbilical vein catheter”. Results and conclusions In the first weeks of life the DV is regularly still patent. It should be recognized as DV and not be mistaken for a pathological portosystemic shunt.The ductus venosus is the lead structure for umbilical vein catheters. Radiologists should be able to assess the correct catheter position. Radiologically important findings of an umbilical vein catheter are mainly malposition and intrahepatic extravasation. Agenesis of the DV can lead to intra- or extrahepatic compensatory portosystemic shunts, in which as well as in the case of persistent patency of the DV, there may be the necessity for radiological-interventional or surgical occlusion. Key points: Citation Format

Evaluation of Umbilical Vein Catheter Position in Neonates by Thoraco-Abdominal Radiography Versus Echocardiography

Background: Umbilical vein catheterization is usually conducted for preterm neonates in neonatal intensive care units to administer medication, fluid and nutrition, and blood transfusion. However, catheter tip malposition can cause complications. Objectives: There are different methods to detect the accuracy of catheter’s position; hence, this study aimed to compare the diagnostic accuracy of radiography vs echocardiography to determine the accurate tip position of umbilical vein catheter. Methods: This cross-sectional study was performed on all 104 neonates admitted to the neonatal intensive care units of hospitals affiliated to Shiraz University of Medical Sciences from March 2017 to January 2018. At first, the length of the catheter was estimated based on Dunn method. After catheterization, thoraco-abdominal radiography and echocardiography were performed by a pediatric radiologist who was blinded to the study objectives, and the data were recorded in two forms. Finally, data were analyzed by McNemar’s test, using SPSS 17 software. Results: The sensitivity, specificity, positive predictive value and negative predictive value by radiography and echocardiography for the catheter tip position in the inferior vena cava-right atrium junction was calculated 100%. Moreover, catheters were located in the ductus venous, inferior vena cava, inferior vena cava-right atrium junction, right and left atrium in echocardiography were in the radiograph equal to thoracic vertebrae of T9-T11, T9, T6-T10, T5-T8, and T4-T6, respectively. Conclusions: Our study suggests that even though echocardiography is as reliable as radiography for early detection of the catheter tip position, it can also avoid complications of catheter malposition quicker than radiography.

582. Impact of Central Line Bundle for Prevention of Umbilical Vein Catheter-Related Bloodstream Infections in a Neonatal Intensive Care Unit

Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures.

Incidence of complications following umbilical vein catheterisation in neonates

Background: Umbilical vein catheter (UVC) insertion in newborns has life threatening complications like Catheter related bloodstream infections (CRBSI), Portal vein thrombosis (PVT) and other mild complications. This study has been done to assess the incidence and risk factors of complications in neonates with umbilical vein catheterisation.Methods: A prospective observational study was carried out in neonates admitted to a South Indian tertiary care hospital between January 2017- June 2018.Results: Umbilical vein catheterisation was done for 65 neonates, of them 46 completed the study. One neonate (2%) developed CRBSI and none of them developed PVT in both baseline and follow up scans. Minor complications noted were repositioning in 26%, umbilical site leak in 23%, reattempts in 19%, catheter block in 13%, periumbilical erythema in 6% and umbilical site bleed in 2%. There was no statistical significance between minor complications and baseline study characteristics.Conclusions: Although UVC is a common and easy vascular access, it is not without complications. Incidence of serious complications following umbilical vein catheterisation is low when proper technique and sterile precautions are followed. However, the occurrence of mild complications following UVC insertion is high.