Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice

Daragh Finn^{1

2}, Hannah Kinoshita³, Vicki Livingstone⁴, Eugene M Dempsey^{5

6}

Affiliations

¹ Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. daraghfinn@gmail.com.
² Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. daraghfinn@gmail.com.
³ Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. hmkinos@gmail.com.
⁴ Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. v.livingstone@ucc.ie.
⁵ Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. g.dempsey@ucc.ie.
⁶ Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. g.dempsey@ucc.ie.

PMID: 29149032
PMCID: PMC5704133
DOI: 10.3390/children4110099

Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice

Daragh Finn et al. Children (Basel). 2017.

. 2017 Nov 17;4(11):99.

doi: 10.3390/children4110099.

Authors

Daragh Finn^{1

2}, Hannah Kinoshita³, Vicki Livingstone⁴, Eugene M Dempsey^{5

6}

Affiliations

¹ Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. daraghfinn@gmail.com.
² Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. daraghfinn@gmail.com.
³ Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. hmkinos@gmail.com.
⁴ Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. v.livingstone@ucc.ie.
⁵ Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. g.dempsey@ucc.ie.
⁶ Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. g.dempsey@ucc.ie.

PMID: 29149032
PMCID: PMC5704133
DOI: 10.3390/children4110099

Abstract

Background: Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants.

Methods: A pre-post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA) was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period.

Results: During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%).

Conclusion: Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.

Keywords: neonatal; newborn intubation; preterm infant; umbilical arterial catheter; umbilical venous catheter.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

**Figure 1**
Accuracy of initial position in pre (black) and post (white)-education groups.

**Figure 2**
Accuracy of initial position for ETT, UAC and UVC in pre and post groups.

See this image and copyright information in PMC

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Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice

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Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice

Authors

Affiliations

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Conflict of interest statement

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