Fluoroscopy-guided Umbilical Venous Catheter Placement in Infants with Congenital Heart Disease.
OBJECTIVE
The objective of this study was to (1) describe the technical aspects of fluoroscopy-guided umbilical venous catheter placement (FGUVCP); and (2) determine the procedural success rate, factors contributing to procedural failure, and risks of the procedure.


BACKGROUND
Umbilical venous catheters are advantageous compared with femoral venous access, but can be difficult to place at the bedside.


METHODS
This was a retrospective chart review from a single tertiary care referral institution.


RESULTS
FGUVCP was successful in 138 of 180 patients (76.7%) over a seven-year period. Patients in whom FGUVCP was successful were younger at the time of procedure compared with patients in whom FGUVCP was unsuccessful (median 18.2 vs. 22.2 hours, P = .03). The optimal age cutoff to predict FGUVCP success was 20 hours with a high positive predictive value (82.4%) but low negative predictive value (32.5%). No other variables were associated with procedural failure, though functional univentricular heart and older gestational age trended toward statistical significance. Median radiation time, contrast exposure, and blood loss were 3.2 minutes, 1 mL, and 1 mL, respectively. A total of 10 complications in 10 patients were associated with FGUVCP.


CONCLUSIONS
FGUVCP is a safe and highly successful way to obtain central venous access in neonates with congenital heart disease. Older age at the time of procedure is associated with procedural failure, but utilization of an age cutoff may not be clinically useful.
Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
Aaron G
AG
DeWitt
Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
Jeffrey D
JD
Zampi
Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
Janet E
JE
Donohue
Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
Sunkyung
S
Yu
Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
Thomas R
TR
Lloyd
D000367:Age Factors; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling; D005260:Female; D005471:Fluoroscopy; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008824:Michigan; D010690:Phlebography; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014471:Umbilical Veins / Q000000981:diagnostic imaging*; D062666:Vascular Access Devices
Catheterization; Central Venous Access; Ductus Venosus; Umbilical Vein