Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital and the University of British Columbia, Canada.
Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
Am J Perinatol. 2022 Dec;39(16):1805-1811. doi: 10.1055/s-0041-1726385. Epub 2021 Apr 14.
Umbilical venous catheters (UVC) are widely used in neonatal intensive care (NICU). Noncentral catheter position is known to be associated with multiple adverse complications; however, risk factors for catheter malposition are unclear. This work aimed to identify clinical risk factors and complications associated with UVC malposition in neonates admitted in an NICU.
A retrospective chart review was performed of inborn babies admitted to BC Women's Hospital NICU with UVC inserted in their first 7 days between July 2016 and June 2018. Infant and maternal demographic, radiograph, UVC-related data, and complications were reviewed.
A total of 257 infants had UVC placed; 158 (61%) and 99 (39%) were in central and noncentral positions after initial placement, respectively. Of initially central-placed UVCs, a further 35 (22%) were pulled back or migrated to malposition on follow-up X-ray. Multivariable logistic regression analysis revealed the use of larger UV (5 Fr) catheter (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.1-5.6, = 0.026) and escalation of respiratory support mode (OR: 1.7, 95% CI: 1.0-2.8, = 0.049) as significant predictors of catheter malposition.
Noncentral UVC position as well as migration were common after initial placement in this cohort. The use of larger size UV catheters and increasingly invasive respiratory support were risk factors associated with higher incidence of UVC malposition. Ongoing surveillance of UVC position is thus recommended.
· More than one-third of UV catheters were not in central position after the initial placement.. · Large size UV catheters and increasingly invasive respiratory support were risk factors for UV malposition.. · High incidence of UVC migration was found after initial central placement, warranting surveillance..
脐静脉导管（UVC）在新生儿重症监护病房（NICU）中广泛使用。已知非中心导管位置与多种不良并发症有关；然而，导管位置不当的危险因素尚不清楚。本研究旨在确定与新生儿重症监护病房（NICU）中 UVC 位置不当相关的临床危险因素和并发症。
对 2016 年 7 月至 2018 年 6 月期间在卑诗省妇女医院 NICU 中出生并在出生后 7 天内插入 UVC 的婴儿进行回顾性图表审查。回顾了婴儿和产妇的人口统计学、射线照片、UVC 相关数据和并发症。
共有 257 名婴儿放置了 UVC；初始放置后，158 名（61%）和 99 名（39%）的 UVC 分别处于中心和非中心位置。在最初放置的中心位置的 UVC 中，进一步的 35 个（22%）在后续 X 光检查中被拉回或迁移到位置不当。多变量逻辑回归分析显示，使用较大的 UV（5 Fr）导管（优势比[OR]：2.5，95%置信区间[CI]：1.1-5.6， = 0.026）和升级呼吸支持模式（OR：1.7，95% CI：1.0-2.8， = 0.049）是导管位置不当的显著预测因素。
在本队列中，初始放置后 UVC 位置不当和迁移很常见。使用较大尺寸的 UV 导管和越来越侵入性的呼吸支持是与 UVC 位置不当发生率较高相关的危险因素。因此，建议对 UVC 位置进行持续监测。
·初始放置后，超过三分之一的 UVC 不在中心位置。·大尺寸 UV 导管和越来越侵入性的呼吸支持是 UV 位置不当的危险因素。·初始中心放置后发现 UVC 迁移发生率较高，需要进行监测。
