Echocardiograms for UVC Position

Echocardiographic Evaluation of Umbilical Venous Catheter Placement.
Ades A, Sable C, Cummings S, et al. J Perinatol (January 2003); 23:24 -28.

Objective: To compare techniques for guiding and confirming placement of umbilical venous catheters (UVCs) using two-dimensional echocardiography.

Study Design: Fifty-three newborns admitted to our neonatal intensive care unit who required an UVC or who were transferred within 24 hours of UVC placement at a referring hospital were studied. UVC position was assessed by antero-posterior (AP) chest radiography (CXR), lateral CXR, and oxygenation data. The accuracy of the above techniques was compared to echocardiography with saline contrast injection.

Results: Echocardiography revealed that UVCs were located ideally at the right atrial/inferior vena cava junction in only 12 (23%) of 53 patients. Twenty-four (45%) were incorrectly positioned in the left atrium. The sensitivity and specificity of AP CXR in evaluating inappropriate UVC position were 32% and 89%, respectively. Lateral CXR and thoracic level on AP CXR did not predict accurately catheter position. UVC pO₂ data were not useful in excluding left atrial placement.

Conclusion: Current methods to determine insertion length and confirm location of UVCs are not adequate. Echocardiography should be considered to confirm correct placement of UVCs.

Comment: Misplacement of UVCs places babies at risk for serious vascular complications including pleural and pericardial effusions, cardiac tamponade, arrhythmias, intracardiac thromboses, systemic and pulmonary emboli, and endocarditis (to name a few). Chest radiographs can no longer be relied upon to accurately localize the position of the UVC tip. Echocardiogram should be the new standard. At the very least, whenever a baby with a UVC in place has an echocardiogram done, the study should include a saline contrast injection to confirm the position of the catheter tip. ABK.