Ultrasound Monitoring of Umbilical Catheters in the Neonatal Intensive Care Unit—A Prospective Observational Study

Introduction: Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. The aim of our study was to determine whether the repeated ultrasound scanning can influence the catheterization time, prevent some of the catheter-related complications, support the decision-making process and allow prolonged catheterization in patients without an alternative central access route.Methods: A prospective observational study was performed in a tertiary neonatal intensive care unit. A total of 129 patients and 194 umbilical catheters (119 venous and 75 arterial) were analyzed with a total of 954 scans. Ultrasound screening consisted of 1) assessing the catheter tip, location, movability, and surface and 2) analyzing the catheter trajectory. The outcome variables were defined as 1) catheter dislocation and 2) associated thrombosis.Results: Dislocation of catheter throughout the whole catheterization period was observed in 68% (81/119) of UVCs and 23% (17/75) of UACs. Thrombotic complications were observed in 34.5% (41/119) of UVCs and 12% (9/75) of UACs. 1/3 of UAC-associated thrombi were visible only after catheter removal. 51% (61/119) of UVC patients and 8% (6/75) of UAC patients made a clinical decision regarding the obtained catheter image.Conclusion: Bedside ultrasound imaging of catheters supports the decision-making process related to the catheterization duration, shortening the time if abnormalities are detected and allowing a safer prolonged UC stay when an alternative central line cannot be inserted.

Off label use of PICC as umbilical arterial catheter: Clinical case series

Umbilical arterial catheters are often placed at birth in critical ill neonates. Advantages of umbilical arterial catheterization include continuous blood pressure monitoring, accurate blood gas and frequent blood samplings. We described the off-label use of a third generation polyurethane power injectable 3 Fr single lumen peripheral inserted central catheter as umbilical arterial catheter. This clinical case series opens new scenarios about the off-label use of power PICC in newborns. Prospective studies are needed to evaluate the safety and advantages of PICCs as umbilical catheters over the conventional old generation polyurethane neonatal catheters.

Umbilical catheter placement and pericardial effusion in neonates: The US national database

We aimed to assess the association of umbilical catheters placement with pericardial effusion (PCE) in newborn infants after controlling for confounding variables. We analyzed three subpopulations: infants with birth weight (BW) > 2500g, infants with BW < 1500g, and infants with congenital heart diseases (CHD). We utilized the US-National Inpatient Sample dataset (1997–2012). First analysis included a 22,822,931 infants with BW > 2500g with no hydrops fetalis. Of them, 2583 neonates (0.01%) had PCE. PCE was found in 0.33% of infants with UAC only, 0.22% of infants with UVC only and 0.37% of infants with both catheters (aOR = 2.7, CI:2.4–3.2, p < 0.001), aOR = 2.8, CI: 2.3–3.5, p < 0.001), and aOR = 2.8, CI: 2.4–3.2, p < 0.001), respectively. The second analysis included a 200,288 infants with CHD and BW > 2500g. Of them, 1130 (0.56%) had PCE. PCE was found in 1.46% of infants with UAC, 0.78% of infants with UVC and 0.98% of infants with both catheters (aOR = 2.1, CI:1.8–2.6, p < 0.001), aOR = 1.4, CI:1.1–1.9, p = 0.036) and a OR = 1.6, CI:1.3–1.9, p < 0.001), respectively. While, a total of 1,187,727 infants with BW < 1500g were included in the third analysis. Of them, 1667 (0.14%) had PCE. PCE was found in 0.15% of infants with UAC, 0.19% of infants with UVC and 0.26% of infants with both catheters. (aOR = 1.1, CI: 0.9–1.3, p < 0.90), aOR = 1.4, CI: 1.2–1.7, p < 0.001) and aOR = 1.6, CI:1.4–1.8, p < 0.001), respectively. Conclusion: Central umbilical catheters are associated with increased risk for pericardial effusion and they may be independently associated with the occurrence of pericardial effusion in infants with congenital heart disease.

Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit

Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced. Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018. Results: The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates. Conclusion: A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.

Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound

BackgroundUmbilical venous catheters (UVCs) are associated with thrombus formation. Most studies on thrombosis in infants with UVCs focus on only one part of the route, and none assessed a control group of infants without UVCs.ObjectiveTo determine the incidence and location of thrombi in infants after umbilical catheterisation and compare this with a control group of infants without umbilical catheters.DesignProspective observational study with serial ultrasonography of the UVC route from the umbilico-portal confluence to the heart. Ultrasonography was performed until day 14 after catheterisation in cases and day 14 after birth in controls.ResultsThrombi in the UVC route were detected in 75% (30/40) of infants with UVCs in the study group, whereas no thrombi were detected in the control group of infants without UVCs (0/20) (p<0.001). Six thrombi (20%) were located in the right atrium. Most of these were also partly present in the ductus venosus. Six thrombi (20%) were located in the ductus venosus only, and in 12 infants (40%), the thrombus was at least partly located in the umbilico-portal confluence. Thrombi persisted after UVC removal in 25/30 cases. Two infants with thrombotic events were treated with low-molecular-weight heparin and resolution was found. In the other 23 infants managed expectantly, 2 died due to necrotising enterocolitis, 1 was lost to follow-up and in 20 spontaneous regression was seen.ConclusionsThrombotic events occur frequently in infants after umbilical catheterisation. Most thrombi were asymptomatic and regressed spontaneously with expectant management. Routine screening for thrombi in UVCs is therefore not advised.