Placement of umbilical venous catheters with use of bedside real-time ultrasonography,☆☆,

https://doi.org/10.1016/S0022-3476(95)70366-7Get rights and content

Abstract

Real-time ultrasonography was used to assess the position of umbilical venous catheters tips in 79 newborn infants (birth weight range, 400 to 4200 gm). The position of the umbilical venous catheters determined by ultrasonography was compared with the projection of the catheter tip on the closest vertebral body shown on a standard chest radiograph. Of the catheters initially placed with radiographic guidance, 56% were repositioned because of unsatisfactory location. Ultrasonography is more precise than radiography because it allows direct visualization of the catheter tips in relation to internal vascular structures. When ultrasonography is unavailable, placement at the ninth thoracic vertebral body ensures safe positioning. (J PEDIATR 1995;126:633-5)

Section snippets

METHODS

Seventy-nine infants (median birth weight, 1600 gm; range, 480 to 4200 gm) admitted to the infant special care unit at the University of California-San Diego Medical Center who required UVC insertion for clinical care were enrolled in the study between June 1992 and December 1993. The protocol was approved by the institutional review board, and parental written consent was obtained. Heparin-bonded polyurethane catheters (5F and 3.5F) were inserted by the clinical team to a distance determined

RESULTS

We compared 95 radiographs and ultrasound studies for 79 patients. In all patients the catheters were easily seen (Fig. 1). Initial placement of 60 UVCs was done with radiographs and ultrasonography was used in placement of the remaining 35 UVCs. Of the 60 catheters placed with radiographic guidance, 34 (56%) were repositioned because of unsatisfactory location, requiring more than one radiograph.

Figure 2 shows the relationship between the anatomic location of the catheters visualized by

DISCUSSION

Our data indicate that real-time ultrasonography at the bedside can be used to determine the position of UVCs in critically ill term and preterm infants. Although the catheters were visualized in all patients, fluid injection was helpful to image the exact position of the tip. Real time ultrasonography was more effective than radiography because the location of the UVC in the body could be determined, and the catheters could be positioned at the RA-IVC junction during the initial insertion

References (5)

  • S Rosen et al.

    Umbilical venous catheterization in the newborn: identification of correct positioning

    Radiology

    (1970)
  • D Baker et al.

    Proper localization of umbilical arterial catheters and venous catheters by lateral roentgenogram

    Pediatrics

    (1969)
There are more references available in the full text version of this article.

Cited by (0)

From the Departments of Neonatology and Pediatrics, University of California-San Diego, San Diego, California

☆☆

Reprint requests: Mark Greenberg, MD, 2220 River Run Dr., No. 113, San Diego, CA 92108.

0022-3476/95/$3.00 + 0 9/24/61032

View full text