Keywords:
Paediatric, Liver, Vascular, Ultrasound, Ultrasound-Colour Doppler, Ultrasound-Power Doppler, Venous access, Localisation, Catheters, Embolism / Thrombosis, Trauma, Obstruction / Occlusion
Authors:
J. P. RAMIREZ1, M. X. escovar2; 1Caracas, Distrito Capital/VE, 2Caracas/VE
DOI:
10.26044/ecr2019/C-0231
Conclusion
The incorrect positioning of the umbilical venous catheter occurs frequently (86.6%) in the NICU and this is usually caused by not using imaging guided catheterization.
Ultrasound should be used to guide the correct positioning of the catheter or to check its placement if it is suspected that it was incorrectly positioned so that it can then be withdrawn.
(2).
The incorrect positioning of the umbilical vein catheter has a statistically significant relationship (p = 0.001) with the presence of portal system complications overall (pneumatosis,
thrombosis and portal cavernomatosis,
as well as hepatic hematomas).
The incorrect positioning of the umbilical vein catheter has a statistically significant relationship (p = 0.001) with the presence of portal pneumatosis evaluated individually.
Although there was a relationship between the incorrect positioning of the umbilical vein catheter and the presence of hepatic hematomas evaluated individually,
a statistically significant relationship was not demonstrated (p = 0.156).
It was not possible to demonstrate a statistically significant relationship between the inadequate positioning of the umbilical vein catheter and the presence of thrombosis and portal cavernomatosis evaluated individually.
This was probably conditioned by the bias generated because due to ethical reasons we removed catheters that were found to be inadequately positioned.
This aspect that would not occur naturally without the completion of the study
We found that the gestational age groups with the highest rate of complications were the moderate preterm group (9 neonates) and the post-term group (1 neonate) in which 100% of subjects had complications.
This frequency did not have a direct relationship with gestational age,
but rather with the incorrect positioning of the umbilical venous catheter,
because in the previously mentioned gestational age groups,
100% had the catheter incorrectly positioned.
The use of alternative venous accesses to umbilical venous catheterization in the NICU is recommended to reduce the incidence of these findings.
In the same way if the placement of an umbilical venous catheter is strictly necessary,
it is recommended that its placement is guided by ultrasound or that ultrasound evaluation is performed in the first hours after its placement.
If it is incorrectly positioned,
it is pertinent to immediately remove the catheter to avoid the development of complications.
Decreasing the frequency of the incorrect positioning will decrease the frequency of complications.
(13).
Follow-up studies in the community should be carried out in the patients identified as having a poorly positioned catheter.
This would help establish if there really is a relationship with the complications that occur in the longer term such as portal thrombosis,
portal cavernomatosis and especially portal hypertension.
Comparative studies of neonates whose catheter has been placed guided by ultrasound should also be carried out,
as well as studies that compare the complication rates in patients who had ultrasonographic evaluation in the first hours after its placement and those who did not.