脐静脉导管意外迁移常导致导管异位。
Inadvertent Migration of Umbilical Venous Catheters Often Leads to Malposition.
机构信息
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands,
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Neonatology. 2019;115(3):205-210. doi: 10.1159/000494369. Epub 2019 Jan 15.
BACKGROUND
Migration of umbilical venous catheters (UVCs) has been described anecdotally.
OBJECTIVES
The aim of this paper was to investigate migration of UVCs using ultrasonography (US).
METHODS
In a prospective observational study, the position of UVCs was determined using serial US within 24 h, at midweek, and at the end of the week after umbilical catheterization. Migration was recorded in distance and direction. Malposition was defined as a position of the UVC in the heart (right atrium or more distal along the UVC-route), umbilicoportal confluence, or in the umbilical vein. UVC position determined by US was compared with chest X-rays (CXRs) when these were performed for standard care within the same period of 1 h.
RESULTS
Migration of UVCs was detected with US in 25/40 infants (63%) in 32 occasions, leading to malposition in 17/25 (68%) infants. UVCs migrated inwards in 18/32 (56%), leading to a position within the heart in 17/18 occasions. Most migrations occurred before Day 3 (21/32 [66%]). When a CXR was taken at the same time as US was performed (30 occasions), the assessment of the catheter-tip position differed in 23% of the occasions. When malposition was detected by US, this was detected on routinely performed CXRs in 11% of the occasions.
CONCLUSIONS
UVCs often migrate following insertion, often leading to malposition. Awareness for this is needed, and US is a feasible alternative for detecting malposition compared to CXRs and avoids additional radiation. Re-evaluation of the position of UVCs at least once, but within 24 h after placement, is recommended.
背景
脐静脉导管（UVC）迁移已有相关描述。
目的
本研究旨在通过超声（US）检查来研究 UVC 的迁移情况。
方法
在一项前瞻性观察研究中，在 UVC 置管后 24 小时内、周中以及周末，通过连续 US 确定 UVC 的位置。记录迁移的距离和方向。UVC 错位定义为 UVC 位于心脏（右心房或更靠近 UVC 路径的远端）、脐门静脉汇合处或脐静脉内。当在同一 1 小时内进行标准护理时拍摄胸片（CXR）时，将 US 确定的 UVC 位置与 CXR 进行比较。
结果
在 40 名婴儿中的 25 名（63%）的 32 次中，通过 US 检测到 UVC 迁移，导致 17/25 名（68%）婴儿出现错位。UVC 向内迁移 18/32 次（56%），导致 17/18 次位于心脏内。大多数迁移发生在第 3 天之前（21/32 [66%]）。当在进行 US 检查的同时拍摄 CXR 时（30 次），导管尖端位置的评估在 23%的情况下存在差异。当 US 检测到错位时，在 11%的情况下，在常规进行的 CXR 上检测到。
结论
UVC 在插入后经常迁移，通常导致错位。需要对此有认识，与 CXR 相比，US 是检测错位的可行替代方法，且避免了额外的辐射。建议在放置 UVC 后至少重新评估一次位置，但不超过 24 小时。
Zotero 插件