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Revised formula to determine the insertion length of umbilical vein catheters

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Abstract

The method of Shukla is commonly used to predict the insertion length of umbilical vein catheters (UVCs) but often leads to over-insertion. Malposition of UVCs can lead to complications. In this study, we compared the formula of Shukla, i.e., \( {{{\left( {3\times \mathrm{birth}\,\mathrm{weight}\,\mathrm{in}\,\mathrm{kg}+9} \right)}} \left/ {2} \right.}+1\mathrm{cm} \) with a revised formula, i.e., \( {{{\left( {3\times \mathrm{birthweight}\,\mathrm{in}\,\mathrm{kg}+9} \right)}} \left/ {2\mathrm{cm}} \right.} \) in determining the insertion length of UVCs. A cohort where the revised formula was used for UVC placement (revised group) was compared with a historical cohort using the conventional formula (Shukla group). We evaluated the position of UVCs stated as the corresponding vertebra level with a radiograph of the infant’s chest and abdomen immediately after insertion in both groups. Positioning of the catheter tip above the ninth or below the tenth thoracic vertebra was considered too high or too low, respectively. Median position of 93 UVCs placed according to Shukla was lower (seventh thoracic vertebra, interquartile range (IQR) 6–9) when compared to 92 UVCs placed according to the revised formula (eighth thoracic vertebra (IQR 7–9)). UVCs were more often over-inserted using the Shukla formula (73 %) when compared to the revised formula (54 %). One UVC in the Shukla group (1 %) and two UVCs in the revised group (2 %) were placed too low (p = NS). Conclusion: The revised formula reduces the rate of over-insertion of UVCs without increasing the rate of inadequate lower positioning.

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References

  1. Ades A, Sable C, Cummings S, Cross R, Markle B, Martin G (2003) Echocardiographic evaluation of umbilical venous catheter placement. J Perinatol 23:24–28

    Article  PubMed  Google Scholar 

  2. Ahluwalia JSBJLKA (2008) Procedures and iatrogenic disorders. In: Rennie JM (ed) Roberton’s textbook of neonatology. Elsevier, Philadelphia, pp 1237–1272

    Google Scholar 

  3. Anderson J, Leonard D, Braner DA, Lai S, Tegtmeyer K (2008) Videos in clinical medicine. Umbilical vascular catheterization. N Engl J Med 359:e18

    Article  PubMed  Google Scholar 

  4. Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney RE Jr, Cotton M, Fisher RG, Alexander KA (2001) Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 107:1272–1276

    Article  PubMed  Google Scholar 

  5. Bradshaw WT, Furdon SA (2006) A nurse’s guide to early detection of umbilical venous catheter complications in infants. Adv Neonatal Care 6:127–138

    Article  PubMed  Google Scholar 

  6. Darling JC, Newell SJ, Dear PR (2001) Placement of neonatal central venous catheter tips in the right atrium: a practice to be avoided? Arch Dis Child Fetal Neonatal Ed 85:F146

    Article  PubMed  CAS  Google Scholar 

  7. Darling JC, Newell SJ, Mohamdee O, Uzun O, Cullinane CJ, Dear PR (2001) Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol 21:461–464

    Article  PubMed  CAS  Google Scholar 

  8. Dunn PM (1966) Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child 41:69–75

    Article  PubMed  CAS  Google Scholar 

  9. Greenberg M, Movahed H, Peterson B, Bejar R (1995) Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr 126:633–635

    Article  PubMed  CAS  Google Scholar 

  10. Haase R, Hein M, Thale V, Vilser C, Merkel N (2011) Umbilical venous catheters—analysis of malpositioning over a 10-year period. Z Geburtshilfe Neonatol 215:18–22

    Article  PubMed  CAS  Google Scholar 

  11. Hermansen MC, Hermansen MG (2005) Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol 32:141–156, vii

    Article  PubMed  Google Scholar 

  12. Hogan MJ (1999) Neonatal vascular catheters and their complications. Radiol Clin North Am 37:1109–1125

    Article  PubMed  CAS  Google Scholar 

  13. Korver AM, Walther FJ, van der Molen AJ, de Beaufort AJ (2007) Serious complications of umbilical venous catheterisation. Ned Tijdschr Geneeskd 151:2219–2223

    PubMed  CAS  Google Scholar 

  14. Michel F, Brevaut-Malaty V, Pasquali R, Thomachot L, Vialet R, Hassid S, Nicaise C, Martin C, Panuel M (2012) Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation 83:705–709

    Article  PubMed  Google Scholar 

  15. Narla LD, Hom M, Lofland GK, Moskowitz WB (1991) Evaluation of umbilical catheter and tube placement in premature infants. Radiographics 11:849–863

    PubMed  CAS  Google Scholar 

  16. Nash P (2006) Umbilical catheters, placement, and complication management. J Infus Nurs 29:346–352

    Article  PubMed  Google Scholar 

  17. Oestreich AE (2010) Umbilical vein catheterization—appropriate and inappropriate placement. Pediatr Radiol 40:1941–1949

    Article  PubMed  Google Scholar 

  18. Onal EE, Saygili A, Koc E, Turkyilmaz C, Okumus N, Atalay Y (2004) Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe? Paediatr Anaesth 14:953–956

    Article  PubMed  Google Scholar 

  19. Pabalan MJ, Wynn RJ, Reynolds AM, Ryan RM, Youssfi M, Manja V, Lakshminrusimha S (2007) Pleural effusion with parenteral nutrition solution: an unusual complication of an “appropriately” placed umbilical venous catheter. Am J Perinatol 24:581–585

    Article  PubMed  Google Scholar 

  20. Pennaforte T, Klosowski S, Alexandre C, Ghesquiere J, Rakza T, Storme L (2010) Increased success rate in umbilical venous catheter positioning by posterior liver mobilization. Arch Pediatr 17:1440–1444

    Article  PubMed  CAS  Google Scholar 

  21. Rand T, Kirchner L, Puig S, Ponhold W, Vergesslich K, Imhof H (2000) “Lines and tubes” in neonatal intensive care patients. Radiologe 40:52–57

    Article  PubMed  CAS  Google Scholar 

  22. Shukla H, Ferrara A (1986) Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child 140:786–788

    PubMed  CAS  Google Scholar 

  23. Simanovsky N, Ofek-Shlomai N, Rozovsky K, Ergaz-Shaltiel Z, Hiller N, Bar-Oz B (2011) Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol 21:1882–1886

    Article  PubMed  Google Scholar 

  24. Stocker M, Berger TM (2006) Arterial and central venous catheters in neonates and infants. Anaesthesist 55:873–882

    Article  PubMed  CAS  Google Scholar 

  25. Verheij G, Smits-Wintjens V, Rozendaal L, Blom N, Walther F, Lopriore E (2009) Cardiac arrhythmias associated with umbilical venous catheterisation in neonates. BMJ Case Rep 2009

  26. Verheij GH, Te Pas AB, Witlox RS, Smits-Wintjens VE, Walther FJ, Lopriore E (2010) Poor accuracy of methods currently used to determine umbilical catheter insertion length. Int J Pediatr 2010:873167

    PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Gerdina H. Verheij.

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Verheij, G.H., te Pas, A.B., Smits-Wintjens, V.E.H.J. et al. Revised formula to determine the insertion length of umbilical vein catheters. Eur J Pediatr 172, 1011–1015 (2013). https://doi.org/10.1007/s00431-013-1981-z

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  • DOI: https://doi.org/10.1007/s00431-013-1981-z

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