Sobczak Alina, Dudzik Aleksandra, Kruczek Piotr, Kwinta Przemko
Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland.
Front Pediatr. 2021 Apr 30;9:665214. doi: 10.3389/fped.2021.665214. eCollection 2021.
Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. The aim of our study was to determine whether the repeated ultrasound scanning can influence the catheterization time, prevent some of the catheter-related complications, support the decision-making process and allow prolonged catheterization in patients without an alternative central access route. A prospective observational study was performed in a tertiary neonatal intensive care unit. A total of 129 patients and 194 umbilical catheters (119 venous and 75 arterial) were analyzed with a total of 954 scans. Ultrasound screening consisted of 1) assessing the catheter tip, location, movability, and surface and 2) analyzing the catheter trajectory. The outcome variables were defined as 1) catheter dislocation and 2) associated thrombosis. Dislocation of catheter throughout the whole catheterization period was observed in 68% (81/119) of UVCs and 23% (17/75) of UACs. Thrombotic complications were observed in 34.5% (41/119) of UVCs and 12% (9/75) of UACs. 1/3 of UAC-associated thrombi were visible only after catheter removal. 51% (61/119) of UVC patients and 8% (6/75) of UAC patients made a clinical decision regarding the obtained catheter image. Bedside ultrasound imaging of catheters supports the decision-making process related to the catheterization duration, shortening the time if abnormalities are detected and allowing a safer prolonged UC stay when an alternative central line cannot be inserted.
脐静脉置管提供了一条快速但要求较高的中心静脉通路，可能会导致其他部位未见的并发症。我们研究的目的是确定重复超声扫描是否会影响置管时间、预防一些与导管相关的并发症、辅助决策过程，并使没有其他中心静脉通路的患者能够延长导管留置时间。在一家三级新生儿重症监护病房进行了一项前瞻性观察研究。共分析了129例患者和194根脐导管（119根静脉导管和75根动脉导管），总共进行了954次扫描。超声筛查包括：1）评估导管尖端、位置、可移动性和表面情况；2）分析导管走行。观察指标定义为：1）导管移位；2）相关血栓形成。在整个置管期间，119根脐静脉导管中有68%（81/119）、75根脐动脉导管中有23%（17/75）出现导管移位。119根脐静脉导管中有34.5%（41/119）、75根脐动脉导管中有12%（9/75）出现血栓形成并发症。1/3的脐动脉相关血栓仅在拔除导管后可见。119例脐静脉导管患者中有51%（61/119）、75例脐动脉导管患者中有8%（6/75）根据获得的导管图像做出了临床决策。导管的床旁超声成像辅助了与导管留置时间相关的决策过程，若检测到异常则缩短时间，并且在无法插入其他中心静脉通路时允许更安全地延长脐静脉导管留置时间。
