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Observational Study
. 2019;115(3):205-210.
doi: 10.1159/000494369. Epub 2019 Jan 15.

Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

Gerdina H Dubbink-Verheij  1 , Remco Visser  2 , Ratna N G B Tan  2 , Arno A W Roest  3 , Enrico Lopriore  2 , Arjan B Te Pas  2
Affiliations
Observational Study

Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition

Gerdina H Dubbink-Verheij et al. Neonatology. 2019.

Abstract

Background: Migration of umbilical venous catheters (UVCs) has been described anecdotally.

Objectives: The aim of this paper was to investigate migration of UVCs using ultrasonography (US).

Methods: In a prospective observational study, the position of UVCs was determined using serial US within 24 h, at midweek, and at the end of the week after umbilical catheterization. Migration was recorded in distance and direction. Malposition was defined as a position of the UVC in the heart (right atrium or more distal along the UVC-route), umbilicoportal confluence, or in the umbilical vein. UVC position determined by US was compared with chest X-rays (CXRs) when these were performed for standard care within the same period of 1 h.

Results: Migration of UVCs was detected with US in 25/40 infants (63%) in 32 occasions, leading to malposition in 17/25 (68%) infants. UVCs migrated inwards in 18/32 (56%), leading to a position within the heart in 17/18 occasions. Most migrations occurred before Day 3 (21/32 [66%]). When a CXR was taken at the same time as US was performed (30 occasions), the assessment of the catheter-tip position differed in 23% of the occasions. When malposition was detected by US, this was detected on routinely performed CXRs in 11% of the occasions.

Conclusions: UVCs often migrate following insertion, often leading to malposition. Awareness for this is needed, and US is a feasible alternative for detecting malposition compared to CXRs and avoids additional radiation. Re-evaluation of the position of UVCs at least once, but within 24 h after placement, is recommended.

Keywords: Malposition; Migration; Umbilical venous catheters.

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Figures

Fig. 1
Fig. 1
Relevant anatomy for the UVC route with too high, correct, and too low locations for the UVC indicated. RA, right atrium; DV, ductus venosus; UPC, umbilicoportal confluence; LPV, left portal vein; RPV, right portal vein; PV, portal vein; IVC, inferior vena cava; UV, umbilical vein; UVC, umbilical venous catheter.
Fig. 2
Fig. 2
Migration of umbilical venous catheters in 40 infants.
See this image and copyright information in PMC

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