Determination of umbilical venous catheter tip position with radiograph

Hoellering, Adam B., Koorts, Pieter J., Cartwright, David W. and Davies, Mark W. (2014) Determination of umbilical venous catheter tip position with radiograph. Pediatric Critical Care Medicine, 15 1: 56-61. doi:10.1097/PCC.0b013e31829f5efa


Author Hoellering, Adam B.
Koorts, Pieter J.
Cartwright, David W.
Davies, Mark W.
Title Determination of umbilical venous catheter tip position with radiograph
Journal name Pediatric Critical Care Medicine   Check publisher's open access policy
ISSN 1529-7535
1947-3893
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1097/PCC.0b013e31829f5efa
Open Access Status Not yet assessed
Volume 15
Issue 1
Start page 56
End page 61
Total pages 6
Place of publication Baltimore, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Objectives: To compare the cardiac silhouette method with the vertebral body method in predicting the umbilical venous catheter tip position on ultrasound; to measure the length of the target zone for the umbilical venous catheter tip; and to determine the time taken for a neonatologist to ascertain position of the umbilical venous catheter tip with ultrasound.
Formatted abstract
Objectives: To compare the cardiac silhouette method with the vertebral body method in predicting the umbilical venous catheter tip position on ultrasound; to measure the length of the target zone for the umbilical venous catheter tip; and to determine the time taken for a neonatologist to ascertain position of the umbilical venous catheter tip with ultrasound.
Design: Prospective cohort study.
Setting: Neonatal ICU.
Patients: Newborn infants with an umbilical venous catheter.
Interventions: Ultrasound scans to determine the umbilical venous catheter tip position were performed within an hour of corresponding anteroposterior chest-abdominal radiograph.
Measurements and Main Results: Two hundred paired radiograph and ultrasound scans in 82 newborn infants were analyzed. Each radiograph was reviewed independently by an experienced neonatologist who recorded the position of the umbilical venous catheter tip by vertebral level and by the cardiac silhouette method. For each method, the sensitivity, specificity, and positive and negative predictive values were calculated for the prediction of the true position of the catheter tip on ultrasound. The umbilical venous catheter tip was well positioned in just 28 of 200 scans. The cardiac silhouette method was superior to the vertebral level method for all test variables, with a sensitivity and specificity of 86% and 94% compared with 61% and 74%. The length of the target zone approximates to a single T8 vertebral body height on radiograph.
Conclusions: For radiograph and ultrasound scans performed within an hour of each other, the cardiac silhouette method more accurately predicts umbilical venous catheter tip than vertebral body level and methods described in previous studies. Catheters are frequently malpositioned. The length of the target zone for optimal umbilical venous catheter tip position is short. Ultrasound assessment of umbilical venous catheter tip position is quick.
Keyword Critical Care Medicine
Pediatrics
General & Internal Medicine
Pediatrics
CRITICAL CARE MEDICINE
PEDIATRICS
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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