Does umbilical venous catheter tip position impact complication rates in neonates?
Thursday, February 13, 2020
4:15 PM – 4:30 PM
Location: Max Bell - MB251
Introduction: Conventional practice is to place umbilical venous catheters (UVCs) in central position and limit the use of low lying catheters. There is limited information regarding the impact of catheter tip position on UVC related complications in neonates.
Objectives: To examine the association between the UVC tip position and UVC related complications in neonates. To evaluate the association between timing (early 12 hours) of UVC insertion and complication rates.
Methods: Design: Retrospective cohort study Inclusion: All infants who had UVC inserted during NICU admission between January 2017 and December 2018 Exclusion: Congenital anomalies, hydrops fetalis, prenatally diagnosed arrhythmia/effusion. Exposure: Position of catheter tip on thoracoabdominal radiograph [Optimum position: catheter tip between T8-10 vertebral level; low position: below T10 and high position: above T8] Outcome: Presence of any one of the following complications: cardiac (arrhythmias, pericardial effusion, thrombosis), hepatic complications, catheter associated infection, and mechanical complications
Results: Of 549 infants, UVC tip was at optimal position in 267 (48.6%), low position in 248 (45.2%) and high position in 34 (6.2%) respectively. Birth weight and gestational age were comparable among the three groups. The overall complication rate was 36/549 (6.5%). The complication rate was 11.7% in high position, 6.8% in low position and 5.6% in optimal position (p=0.36). Cardiac complications were more frequent in the high UVC group compared to optimum position group (8.8% vs 0.37%, OR 10; 95% CI 1.84, 56.5). There was no significant difference in UVC related complications between early and late UVC insertion (6.9 % versus 5.7%, OR 2.49; 95% CI 0.34, 17.8).
Conclusion: UVC related complications were more frequent in infants with high UVC position and least among those with optimal UVC position. Cardiac complications were more frequent in the high UVC group. There was no difference in complication rates between early and late UVC insertion.