The assessment of ultrasound confirmation of umbilical venous catheter positioning by thoracoabdominal x-ray in newborns

Abstract

Background: Umbilical venous catheter (UVC) is the most common and convenient method of central venous access in sick newborn infants. Thoracoabdominal x-ray (TAX) is the most widely used method to confirm UVC position. However, serious complications could be found despite the correct position as seen on TAX, supported that TAX only might notbbe adequate to evaluate UVC tip position. bNowadays, the availability of bedside ultrasound allowed its place in many NICUs and
the recent studies had evaluated the superior role of ultrasound in UVC positioning inb comparison to the gold standard TAX
Objective: To evaluate the ultrasound confirmation of umbilical venous catheter positioning by thoracoabdominal x-ray in newborns
Method: A single-center-based retrospective study. Patients are all neonates admitted in NICU, Bhumibol Adulyadej Hospital who require umbilical venous catheter insertion during November 2019 to September 2021. All UVC insertions were evaluated the position both by thoracoabdominal x-ray (TAX) and ultrasound. The correct UVC tip position was at IVC-RA junction determined by ultrasound.The protocol was approved by the ethic review committee.
Results: The estimated correct UVC tip position in IVC-RA junction by using ultrasound confirmation was 22 from 74 catheter insertions (29.7%), T8 level had the highest rate of correct position (13.5%) and the other incorrect positions were the most common at RA (51.3%). In addition, the result of ≤ 1500 and >1500 g birth weight newborns were similar which was the percentage of incorrect UVC positioning at 70.5 and 70% respectively with no statistically significance.
Conclusion: This study supported that the use of TAX alone was not adequate in determining the proper position of UVC tip in neonates. Regardless of the birth weight. The use of ultrasound assisted clinicians in the proper placement of the UVC tips by providing appropriate visual anatomical detail in the image.