[Positioning of umbilical vein catheter with ECG-guided technique: randomized study].
OBJECTIVE
To evaluate the effectiveness of electrocardiography-guided technique to aid in the correct positioning of umbilical vein catheters.


METHODS
A prospective, randomized controlled study.


METHODS
Term and preterm newborns who required an umbilical venous catheter were managed by an ECG-guided technique (group A) or by a conventional method (group B). Correct positioning was defined by a chest-X-ray when the catheter tip was located above the diaphragm and outside the right atrium. For the ECG-guided technique we utilized a conductive device Vygocard (Medival, Padova) inserted in a 3-way stopcock connected with the catheter. The catheter was inserted under ECG observation until the appearance of a tall P-wave in lead III, which indicated the tip was within the right atrium. The catheter was then withdrawn until the P wave size returned to normal.


RESULTS
We enrolled 44 patients (16 F, 28 M). Median gestational age (GA) and birth weight (BW) were 34 weeks (range 26-41) and 2130 g. (590-3870), respectively. Sex distribution, GA, BW and Apgar scores were not different between patients in group A (n = 22) and group B (n = 22). Catheters could not be advanced till the estimated insertion depth in 11 patients (A = 5, B = 6). In the remaining 33 patients, correct tip placement was more frequent in group A (88%) compared with group B (50%) (p = 0.021 by Fisher's exact test). No side effects specific to the ECG-guided method were noted.


CONCLUSIONS
The ECG-guided technique seems to be a safe and effective method for the proper placement of umbilical vein catheters in newborns.
Biban
P
P
Cattedra e Divisione di Pediatria, Ospedale Civile Maggiore, Università di Verona.
Cavalli
C
C
Santuz
P
P
Soffiati
M
M
Rugolotto
S
S
Zangardi
T
T
D002404:Catheterization; D002405:Catheterization, Central Venous / Q000379:methods*; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D014471:Umbilical Veins