Henderson Robert D E, Padash Sirwa, Adams Scott J, Augusta Carolyn, Yi Xin, Babyn Paul
Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Finance and Management Science, Edwards School of Business, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Am J Perinatol. 2024 May;41(S 01):e2299-e2306. doi: 10.1055/s-0043-1771051. Epub 2023 Jul 20.
Neonatal catheters and tubes are commonly used for monitoring and support for intensive care and must be correctly positioned to avoid complications. Position assessment is routinely done by radiography. The objective of this study is to characterize neonatal catheter and tube placement in terms of the proportion of those devices that are malpositioned.
Using an institutional dataset of 723 chest/abdominal radiographs of neonatal intensive care unit (ICU) patients (all within 60 days of birth), we assessed the proportion of catheters that are malpositioned. Many radiographs contained multiple catheter types. Umbilical venous catheters (UVCs; 448 radiographs), umbilical arterial catheters (UACs; 259 radiographs), endotracheal tubes (ETTs; 451 radiographs), and nasogastric tubes (NGTs; 603 radiographs) were included in our analysis.
UVCs were malpositioned in 90% of radiographs, while UACs were malpositioned in 36%, ETTs in 30%, and NGTs in just 5%. The most common locations in which UVCs were malpositioned were in the right atrium (31%) and umbilical vein (21%), and for UACs the most common malpositioned tip location was the aortic arch (8%). For the remaining tubes, 5% of ETTs were found to be in the right main bronchus and 4% of NGTs were found in the esophagus.
A substantial proportion of catheters and tubes are malpositioned, suggesting that optimizing methods of catheter placement and assessment ought to be areas of focus for future work.
· Neonatal catheters are frequently malpositioned.. · Most umbilical venous catheters need readjustment.. · X-ray and ultrasound are important for assessment.. · Catheter tips should be assessed in all X-rays..
新生儿导管和管道常用于重症监护的监测和支持，必须正确放置以避免并发症。位置评估通常通过放射照相进行。本研究的目的是根据放置不当的装置比例来描述新生儿导管和管道的放置情况。
利用一个机构数据集，其中包含723张新生儿重症监护病房（ICU）患者的胸部/腹部X光片（均在出生60天内），我们评估了放置不当的导管比例。许多X光片包含多种导管类型。我们的分析纳入了脐静脉导管（UVC；448张X光片）、脐动脉导管（UAC；259张X光片）、气管内导管（ETT；451张X光片）和鼻胃管（NGT；603张X光片）。
90%的X光片中UVC放置不当，而UAC放置不当的比例为36%，ETT为30%，NGT仅为5%。UVC放置不当最常见的位置是右心房（31%）和脐静脉（21%），对于UAC，放置不当最常见的尖端位置是主动脉弓（8%）。对于其余的管道，5%的ETT位于右主支气管，4%的NGT位于食管。
相当一部分导管和管道放置不当，这表明优化导管放置和评估方法应成为未来工作的重点领域。
·新生儿导管经常放置不当。·大多数脐静脉导管需要重新调整。·X光和超声对评估很重要。·在所有X光片中都应评估导管尖端。
