A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore

INTRODUCTION@#Umbilical venous catheters (UVCs), commonly inserted in neonates for vascular access, are not without complications.@*METHODS@#A single-centre retrospective cohort study that reviewed complications related to UVC insertion in neonates was conducted in a tertiary neonatal unit in Singapore from January 2016 to July 2017. Ideal UVC position was defined as catheter tip within 0.5 cm above or below the diaphragm. Catheter-related sepsis was defined as clinical or biochemical abnormalities suggesting any new-onset or worsening sepsis 72 hours before or after removal of UVCs, with or without positive culture. Catheter-associated bloodstream infection (CABSI) was defined as positive microbiological growth in one or more blood cultures obtained from a symptomatic infant up to two days after UVC placement or within 48 hours of catheter removal.@*RESULTS@#108 patients had UVC insertions. Mean gestational age and birth weight were 30.4 ± 4.0 weeks and 1,536.2 g ± 788.9 g, respectively. Mean UVC duration was 6.6 days. The UVC was in an ideal position in 27 (25.0%), deep in 13 (12.0%) and short in 35 (32.4%) neonates. One-third of the UVCs (n = 33) were malpositioned. Catheter-related sepsis was observed in 16 (14.8%) neonates, with 5 (4.6%) having CABSI. The most common organism was coagulase-negative Staphylococcus. Other complications include peritoneal extravasation in 3 (2.8%) patients, with two requiring surgical intervention. Venous thrombosis occurred in 2 (1.9%) neonates and was managed conservatively.@*CONCLUSION@#Although complication rates were in line with international norms, UVCs were associated with serious complications and should be judiciously used.

Umbilical Venous Catheter Complication Presenting as Chylous Ascites in a Newborn: Intraperitoneal Extravasation of Total Parenteral Nutrition Infusate

Umbilical venous catheterization (UVC) is a common practice in intensive neonatal care. However, a malpositioned UVC and its prolonged use may lead to various problems, including mechanical, infectious, and thrombotic complications in various organs such as the liver, lungs, and heart. Congenital chylous ascites is characterized by abnormally high levels of triglycerides in the peritoneal fluid of newborns, which originate from refluxed lymph within the abdominal cavity. Herein, we report a case of an UVC complication presenting as chyloperitoneum simulating congenital chylous ascites in a preterm neonate that resulted from total parenteral nutrition (TPN) extravasation from a malpositioned UVC. Biochemical analysis of intraperitoneal chylous fluid and TPN infusate could help confirm the origin of chyloperitoneum. This case suggests that TPN extravasation from UVC should be considered when chyloperitoneum develops in newborns with an indwelling catheter. UVC positions must also be carefully monitored at regular intervals to recognize associated complications early, particularly in cases with an inevitably malpositioned catheter related to the anatomy of the vessel course.

Liver abscess secondary to umbilical catheterization in a newborn / Absceso hepático asociado con cateterización umbilical en un neonato

We present a case of liver abscess in a 34-week preterm infant after umbilical venous catheterization (UVC). The infant had clinical symptoms of intestinal sepsis, with an encapsulated hypodense hepatic focal lesion with air inside, as observed by abdominal tomography. Staphylococcus aureus was isolated in blood cultures. Liver abscess is a rare complication associated with umbilical catheterization and can be prevented by implementing an appropriate prevention program.

Presentamos un caso de un absceso hepático en una prematura de 34 semanas. La niña presentó síntomas clínicos de sepsis intestinal con una imagen de lesión hipodensa conteniendo aire en hígado en la tomografía de abdomen. Se aisló Staphylococcus aureus en cultivos de sangre. El absceso secundario a colocación de catéter venoso umbilical es infrecuente y puede ser prevenido con un programa preventivo adecuado.

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition / Presença de ar no sistema porta hepático associada a cateter umbilical venoso mal posicionado

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Apresentamos um caso relacionado a cateter umbilical venoso mal posicionado, associado à presença de ar no sistema portal, em um recém-nascido prematuro. A hipótese de enterocolite necrosante foi considerada inicialmente, porém o recém-nascido evoluiu sem achados da doença, tendo o ar desaparecido em radiografia de controle. O diagnóstico diferencial deste achado evita condutas clínicas desnecessárias.

Pericardial Tamponade in a Newborn Following Umbilical Catheter Insertion.

We present a case of cardiac tamponade following umbilical venous catheterization in a neonate, an uncommon, yet potentially fatal complication. Timely diagnosis by echocardiography and urgent pericardiocentesis proved lifesaving.

Two Cases of Solitary Liver Abscess in Preterm Infant Suspiciously Caused by Umbilical Venous Catheter

Solitary liver abscess in neonate is a rare disorder. It is different from multiple liver abscess in aspect of having more subacute course and relative lack of systemic symptoms. Solitary liver abscess is caused by direct bacterial invasion from contiguous infection or hepatic artery during bacterial hematogenous dissemination or by bacterial invasion of the biliary duct and the portal vein. We describe two cases of solitary liver abscess in preterm infant who had umbilical venous catheter for parenteral nutrition.

A Study of the Comparison of Uitrasonography with Radiography to Localize the Umbilical Venous Catheter in the Neonate

PURPOSE: Incorrect umbilical venous catheter(UVC) position results in an increased incidence of complications and rnisleading pressure measurements. Most modern catheters are radiopaque and are easily seen on plain film radiographs but the exact relation of the catheter tip to vascular anatomic landmarks is not available. We assessed the ability of ultrasonography to locate the tip of UVC. And we described the relationship between the locations of the tip of UVC on the ultrasonography and the anatomical landmark seen on the radiography. METHODS: From February 1997 to June 1997, 40 newborns admitted to NICU at Guro Hospital, Korea University, and required UVC insertion for clinical care. UVC position was checked by anteroposterior and cross table lateral radiography. And then ultrasonographic assessment was performed using Hewlett Packard Sonos-1000(Hewlett Packard, UK) with a 5 MHz transducer. The ultrasonographic examinations were documented on hard copy and compared with current plain film radiographs. The sensitivity, specificity, positive predictive value, negative predictive value for the radiography as a test to detect properly positioned UVC were calculated. RESULTS: 1) In 23 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8-T10), but ultrasonographic examination showed that 3 UVCs were malpositioned(false positive value 13%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 76.9%, specificity of 78.6%, positive predictive value of 87% and negative predictive value of 64.7%. 2) In 13 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8- T9), ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 0%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 51.9%. 3) In 18 of 40 newborns the UVCs were properly positioned by cross table lateral radio- graphy(less than 7mm between diaphragm and tip of UVC), but ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 10.5%). Detection of properly located UVC by cross table lateral radiography had a sensitivity of 69.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 63.6%. CONCLUSION: Ultrasonographic catheter localization is a noninvasive technique that uses no ionizing radiation and has no known deterimental side effects, and allows direct visualization of the pertinent vascular anatomy and provides more information than traditional radiography. Use of ultrasonographic guidance at the time of UVC insertion allows the catheter position to be immediately adjusted, with confirmation of the amended position, obviating the need for repeated radiological evaluations. When ultrasonography is unavailable, proper placement of UVC can be estimated by use of radiography to position the tip of UVC between the eighth and ninth thoracic vertebral body by anteroposterior radiography and less than 7mm above or below the diaphragm by cross table lateral radiography.