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  • Original Article
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Simple measurements to place umbilical catheters using surface anatomy

Journal of Perinatology volume 35, pages 476–480 (2015)Cite this article

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Abstract

Objective:

To use external anatomical landmarks to determine a new method for the estimation of appropriate insertion length of umbilical catheters, suitable for newborn infants of varying birth weight (BW) and gestational age.

Study design:

Neonates who had umbilical venous (UVC) or arterial (UAC) catheters placed soon after birth were included in the study. Catheters were placed using formulas derived by Shukla (1986) and/or Wright (2007), and adjusted to appropriate positions confirmed radiologically: UAC tip between T6–T10 vertebral bodies and UVC at the level of the diaphragm±0.5 cms. Final catheter length was compared with the length estimated by Shukla/Wright formulas and to four additional morphometric measurements: umbilicus to nipple (UN), umbilicus to midpoint of inter-mammary distance, umbilicus to xiphoid process and umbilicus to symphysis pubis (USp).

Result:

Of 216 infants, 32 were excluded; UVC was placed in 170 infants and UAC in 125 infants. Among the morphometric measurements, UN−1 cm ( UN distance minus 1 cm) provided the best estimate of accurate insertion length of UVC, (r=0.984, P<0.001) and estimated correct insertion length of 94% of UVCs compared with 57% accuracy with Shukla formula for all BW categories (P<0.001). Morphometric measurement UN−1+2 USp (UN distance minus 1 cm plus twice the distance from umbilicus to symphysis pubis) showed significantly better correlation with appropriate insertion length of UAC (r=0.985, P<0.001) and estimated correct insertion length of 92% of UACs in all infants as compared with 57% accuracy with Shukla formula (P<0.001), and the correct insertion length in 94% of very low BW infants as compared with 68% accuracy with Wright formula (P<0.001).

Conclusion:

Simple and intuitive morphometric measurements UN and USp provide more accurate estimates of appropriate insertion lengths for umbilical catheters in infants with all BWs than commonly used BW-based formulas.

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References

  1. Said M, Rais-Bahrami K . Umbilical artery catheterization and umbilical vein catheterization. In: MacDonald M, Ramasethu J, Rais- Bahrami K (eds). Atlas of Procedures in Neonatology, 5th edn. Wolters Kluwer Lippincott Williams & Wilkins: Philadelphia, PA, USA,, 2013, pp 156–179.

    Google Scholar 

  2. Dunn PM . Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child 1966; 41: 69–75.

    Article  CAS  Google Scholar 

  3. Shukla H, Ferrara A . Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child 1986; 140: 786–788.

    CAS  Google Scholar 

  4. Wright IM, Owers M, Wagner M . The umbilical arterial catheter: a formula for improved positioning in the very low birth weight infant. Pediatr Crit Care Med 2008; 9: 498–501.

    Article  Google Scholar 

  5. Sritipsukho S, Sritipsukho P . Simple and accurate formula to estimate umbilical arterial catheter length of high placement. J Med Assoc Thai 2007; 90: 1793–1797.

    PubMed  Google Scholar 

  6. Verheij GH, te Pas AB, Smits-Wintjens VE, Sramek A, Walther FJ, Lopriore E . Revised formula to determine the insertion length of umbilical vein catheters. Eur J Pediatr 2013; 172: 1011–1015.

    Article  Google Scholar 

  7. Vali P, Fleming SE, Kim JH . Determination of umbilical catheter placement using anatomic landmarks. Neonatology 2010; 98: 381–386.

    Article  Google Scholar 

  8. Verheij GH, Te Pas AB, Witlox RS, Smits-Wintjens VE, Walther FJ, Lopriore E . Poor accuracy of methods currently used to determine umbilical catheter insertion length. Int J Pediatr 2010; 2010: 873167.

    Article  Google Scholar 

  9. Kumar PP, Kumar CD, Nayak M, Shaikh FA, Dusa S, Venkatalakshmi A . Umbilical arterial catheter insertion length: in quest of a universal formula. J Perinatol 2012; 32: 604–607.

    Article  CAS  Google Scholar 

  10. Schlesinger AE, Braverman RM, DiPietro MA . Pictorial essay. Neonates and umbilical venous catheters: normal appearance, anomalous positions, complications, and potential aid to diagnosis. AJR Am J Roentgenol 2003; 180: 1147–1153.

    Article  Google Scholar 

  11. Ramasethu J . Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol 2008; 35: 199–222.

    Article  Google Scholar 

  12. Barrington KJ . Umbilical artery catheters in the newborn: effects of position of the catheter tip. Cochrane Database Syst Rev 2000; CD000505.

  13. Lopriore E, Verheij GH, Walther FJ . Measurement of the 'shoulder-umbilical' distance for insertion of umbilical catheters in newborn babies: questionnaire study. Neonatology 2008; 94: 35–37.

    Article  Google Scholar 

  14. Greenberg M, Movahed H, Peterson B, Bejar R . Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr 1995; 126: 633–635.

    Article  CAS  Google Scholar 

  15. Hoellering AB, Koorts PJ, Cartwright DW, Davies MW . Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med 2014; 15: 56–61.

    Article  Google Scholar 

Download references

Acknowledgements

No external funding was secured for this study.

Author Contributions

AOG contributed to the study design, collected and analyzed the data, and drafted the initial manuscript. MRP conceived the idea that external morphometric measurements should correlate with the internal anatomy for umbilical catheter placement, obtained pilot data, contributed to the study design and writing the manuscript. JR designed the study, coordinated and supervised data collection and analysis, reviewed and revised the manuscript. All authors have reviewed and approved the final manuscript as submitted.

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Authors and Affiliations

  1. Nemours/Alfred I DuPont Hospital for Children, Wilmington,, DE, USA

    A O Gupta

  2. MedStar Georgetown University Hospital, Washington, DC, USA

    M R Peesay & J Ramasethu

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  1. A O Gupta
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  2. M R Peesay
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  3. J Ramasethu
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Correspondence to J Ramasethu.

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Gupta, A., Peesay, M. & Ramasethu, J. Simple measurements to place umbilical catheters using surface anatomy. J Perinatol 35, 476–480 (2015). https://doi.org/10.1038/jp.2014.239

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