Ultrasound improves umbilical vein catheter positioning in newborns


NEW YORK (Reuters Health) - Neonatal placement of umbilical vein catheters can be reliably guided by thoraco-abdominal x-ray or ultrasound, but ultrasound more accurately confirms the position of the catheter tip.

Those findings were reported online December 6 in Resuscitation by Dr. Fabrice Michel and colleagues with the Centre Hospitalo-Universitaire Nord in Marseille, France.

"We now systematically control catheter position using US (ultrasound) in our unit," they comment.

They note that umbilical vein catheters can end up in the liver, or be advanced so far that the tip enters the right atrium or even the left atrium via the foramen ovale.

They add that thoraco-abdominal antero-posterior x-ray (TAX) is most often used to confirm the catheter routing and tip position, but recent studies have indicated that US may be more accurate.

Their study compared the two methods in 60 neonates who required 61 umbilical vein catheters. TAX was used to control the catheter position, and then independent US examinations were performed. The actual catheter route and tip position were determined jointly by senior pediatric radiologists and neonatologists.

Based on this "gold standard" judgment, 28 catheters were correctly routed into a central placement and 15 were adequately positioned in the inferior vena cava. Agreement with these determinations was 85% using TAX and 95% using US, the report indicates.

In terms of the actual catheter tip position, TAX results were concordant with the gold-standard determinations 64% of the time while US concordance was 95%. Furthermore, the accuracy of TAX in defining the tip position decreased with increasing birthweight, the authors found.

"Our results indicate that US should replace TAX for determining UVC (umbilical venous catheter) route and tip position in most neonates," Dr. Michel and colleagues conclude.

"US examination is not available in all NICUs," they point out, "but we encourage NICU practitioners to develop this technique."

Source: http://bit.ly/vsvBpL

Resuscitation 2011.

Last Updated: 2011-12-16 14:28:09 -0400 (Reuters Health)

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