Echocardiographic evaluation of umbilical venous catheter placement.
OBJECTIVE
To compare techniques for guiding and confirming placement of umbilical venous catheters (UVCs) using two-dimensional echocardiography.


METHODS
Fifty-three newborns admitted to our neonatal intensive care unit who required an UVC or who were transferred within 24 hours of UVC placement at a referring hospital were studied. UVC position was assessed by antero-posterior (AP) chest radiography (CXR), lateral CXR, and oxygenation data. The accuracy of the above techniques was compared to echocardiography with saline contrast injection.


RESULTS
Echocardiography revealed that UVCs were located ideally at the right atrial/inferior vena cava junction in only 12 (23%) of 53 patients. Twenty-four (45%) were incorrectly positioned in the left atrium. The sensitivity and specificity of AP CXR in evaluating inappropriate UVC position were 32% and 89%, respectively. Lateral CXR and thoracic level on AP CXR did not predict accurately catheter position. UVC pO(2) data were not useful in excluding left atrial placement.


CONCLUSIONS
Current methods to determine insertion length and confirm location of UVCs are not adequate. Echocardiography should be considered to confirm correct placement of UVCs.
Ades
Anne
A
Department of Neonatology, Children's Hospital of Philadelphia, PA 19104, USA.
Sable
Craig
C
Cummings
Susan
S
Cross
Russell
R
Markle
Bruce
B
Martin
Gerard
G
D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling; D004452:Echocardiography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D014471:Umbilical Veins