title: Rates of intracardiac umbilical venous catheter placement in neonates.
abstract: OBJECTIVE
  To review umbilical venous catheter (UVC) placement in neonates who underwent targeted neonatal echocardiography (TNE) and to correlate catheter tip placement on TNE and anteroposterior thoracoabdominal radiography.
  
  
  METHODS
  We conducted a retrospective analysis of 51 neonates who had UVC positions assessed by TNE and radiography in a neonatal intensive care unit (NICU). A single operator performed all TNE examinations. The final radiographic catheter placement was taken from the image closest to the time of echocardiography. Fisher exact, χ(2), and t tests were used as appropriate.
  
  
  RESULTS
  Among the 51 neonates who had catheters placed for 24 hours or more, TNE was performed on 48 in the first 48 hours, 2 at day 6, and 1 at day 9. Thirty-six neonates were extremely low birth weight (ELBW; <1000 g). Twenty-nine had good catheter tip positions, and 22 had catheters inside the heart (10 in the right atrium [RA], 3 at the foramen ovale, and 9 in the left atrium [LA]). Twenty neonates with catheter tips in the heart were ELBW, including 8 with catheters in the LA. The ELBW neonates were more likely to have catheters in the heart than non-ELBW neonates (20 of 36 versus 2 of 15; P= .01; odds ratio [OR], 8.1; confidence interval [CI], 1.59-41.3). Good placement on TNE varied widely in relation to thoracic vertebral landmarks on radiography: from the T7-8 interspace to T11. When radiography showed a catheter tip at T9-T10, there was no difference in the proportion of neonates with a good catheter position versus malposition (8 of 22 versus 8 of 29; P = .55; OR, 0.67; CI, 0.20-2.19).
  
  
  CONCLUSIONS
  A high proportion of ELBW neonates in a busy NICU had UVCs placed with the tips in the RA or LA despite common placement practices. We recommend adding TNE to radiography to position UVCs, especially in ELBW neonates.
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. andrei.harabor@albertahealthservices.ca.
authors.forename: Andrei
authors.initials: A
authors.lastname: Harabor
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Amuchou
authors.initials: A
authors.lastname: Soraisham
mesh_terms: D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D004452:Echocardiography; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D014471:Umbilical Veins / Q000000981:diagnostic imaging*
keywords: echocardiography; neonate; point-of-care ultrasound; radiography; sonography; umbilical venous catheter