[Malpositioning of umbilical vessel catheters]

Abstract

Background: Catheterization of umbilical veins and arteries is a common intervention in newborns. Malpositioning of catheters is associated with complications. The objective of this study was to evaluate catheter positions after insertion.

Material and methods: The study is based on retrospective evaluation of all relevant X-ray images of newborns admitted to the neonatal intensive care unit, Vestfold Hospital, Norway in the period 1.06.98 - 28.02.10. Accurate localization of the catheter tip was determined in all images. In term infants, acceptable positioning for venous catheters was defined as <or= 10 mm above or below the level of diaphragma and in preterm infants <or= 5 mm. For arterial catheters, acceptable positioning of the catheter tip (irrespective of gestational age) was at the level of the 6th to 9th thoracic vertebral body (high position, preferred) or at the 3rd to 4th lumbar vertebral body (low position).

Results: 278 umbilical vein and 99 umbilical artery catheters were inserted in 298 patients. 45/99 (45 %) of the arterial catheters and 77/278 (28 %) of the venous catheters were correctly positioned from the start. Significantly more arterial catheters were positioned too low (44/99; 44 %) than too high (10/99; 10 %) (p < 0.001). Correspondingly, more venous catheters were positioned too low (126/278; 45 %) than too high (75/278; 27 %) (p < 0.001). Coiling occurred in 14 (5 %) venous catheters and in 6 (6 %) arterial catheters.

Interpretations: Umbilical vessel catheters are often malpositioned. This increases the risk of thromboses and circulation disturbances. X-ray images are important for evaluation and potential correction of the catheter position.