Finn Daragh, Kinoshita Hannah, Livingstone Vicki, Dempsey Eugene M
Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland.
Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
Children (Basel). 2017 Nov 17;4(11):99. doi: 10.3390/children4110099.
Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants.
A pre-post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA) was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period.
During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%).
Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.
气管内插管（ETT）和脐静脉导管（UC）的放置在极早产儿护理中至关重要。本研究的目的是评估一项教育举措对优化极早产儿ETT和UC正确放置的效果。
采用前后对照研究设计，评估胎龄小于32周（GA）的婴儿出生后72小时内ETT和UC的最佳放射学位置。基线数据来自之前34个月的时间段。研究干预包括干预前审核的信息、用于优化UC定位的新生儿体表解剖图像，以及基于体重的计算以估计气管插管的插入深度。然后在12个月的时间内对ETT和UC的放射学放置进行前瞻性评估。
在研究期间，211名婴儿至少接受了三种操作中的一种。157名婴儿被纳入教育前组，54名婴儿被纳入教育后组。教育前组50.3%（79/157）的婴儿接受了所有三种操作，教育后组为55.6%（30/54）。引入教育课程后，准确放置方面没有显著差异；ETT深度（50%对47%）、脐动脉导管（UAC）（40%对43%）和脐静脉导管（UVC）（14%对23%）。
尽管对工作人员进行了关于ETT、UVC和UAC合适插入长度方法的教育，但初始准确插入深度的比例仍不理想。需要评估确定最佳位置的新方法。
