Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Umbilical Venous Catheter Placement in Neonates: A Retrospective, Observational Study

Vito D'Andrea; Giorgia Prontera; Francesco Cota; Alessandro Perri; Rosellina Russo; Giovanni Barone; Giovanni Vento

doi:10.1159/000538905

Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Umbilical Venous Catheter Placement in Neonates: A Retrospective, Observational Study

Neonatology. 2024 Jun 21:1-6. doi: 10.1159/000538905. Online ahead of print.

Authors

Vito D'Andrea¹, Giorgia Prontera¹, Francesco Cota¹, Alessandro Perri¹, Rosellina Russo², Giovanni Barone³, Giovanni Vento¹

Affiliations

¹ Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
² Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
³ Neonatal Intensive Care Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy.

PMID: 38934171
DOI: 10.1159/000538905

Abstract

Introduction: The umbilical venous catheter is a vital access device in neonatal intensive care units for preterm and critically ill infants. Correct positioning is crucial, as malpositioning can lead to severe complications. According to international guidelines, the position of the umbilical venous catheter tip must be assessed in real time; traditionally, the catheter is visualized with a thoracoabdominal X-ray, but one of the most effective and safest methods is therefore real-time ultrasound.

Methods: This study compares real-time ultrasound and traditional X-ray methods for assessing umbilical venous catheter tip location in 461 cases. The rate of tip malposition was analyzed retrospectively. The secondary aim was to assess indwelling time of umbilical venous catheters and reasons of removal.

Results: Real-time ultrasound tip location, found to be more reliable and efficient, demonstrated a significantly lower incidence of primary malpositioning compared to X-ray assessments (9.6 vs. 75.9%). The study also highlighted the association of real-time ultrasound with reduced catheter manipulation, fewer radiographs, and higher indwelling times of umbilical venous catheter. The multiple logistic regression showed a high probability of the central safe position of the umbilical venous catheter tip using real-time ultrasound tip location (odds ratio 29.5, 95% confidence interval: 17.4-49.4).

Conclusion: The findings support the adoption of real-time ultrasound in clinical settings to enhance umbilical venous catheter placement accuracy and minimize associated risks. A minimal training investment is needed to attain the proficiency to visualize the umbilical venous catheters, offering a substantial advantage in terms of both cost-effectiveness for the procedure and enhanced patient safety.

Keywords: Central venous catheters; Hepatic veins; Infant; Neonatal intensive care; Ultrasound; Umbilical venous catheter; Vascular access devices; X-rays.