Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

A novel and accurate method for estimating umbilical arterial and venous catheter insertion length

Journal of Perinatology volume 41, pages 1633–1637 (2021)Cite this article

Subjects

Abstract

Objective

To develop a novel, rapid, and more accurate model for estimating umbilical arterial (UAC) and venous catheter (UVC) insertion length.

Study design

We evaluated UACs and UVCs from a retrospective cohort to determine the rate of correct initial positioning based on conventional birth weight-based equations utilized in our neonatal intensive care unit. We then derived new equations, developed the mobile application, UmbiCalc, to simplify implementation of the new equations, and validated their accuracy with prospective utilization.

Results

The conventional equations successfully predicted insertion length in 69% (364 of 524) of UACs and only 36% (194 of 544) of UVCs. Our new model was prospectively applied to 68 UAC and 80 UVC placements with successful initial positioning achieved in 90% [95% CI, 80.2–94.9] and 76% [95% CI, 65.9–84.2], respectively.

Conclusions

Our novel approach more accurately estimates UAC and UVC insertion length.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Piece-wise linear regression models for UACs (A) and UVCs (B).
Fig. 2: Flow chart of exclusion criteria for retrospective cohort.
Fig. 3: Successful initial placement using the new model compared to the Shukla equations.

References

  1. Pignotti MS, Monciotti F, Frati P, Fineschi V. Hepatic laceration due to umbilical venous catheter malpositioning. Pediatr Neonatol. 2017;58:386–7.

    Article  Google Scholar 

  2. Johnson JF, Basilio FS, Pettett PG, Reddick EJ. Hemoperitoneum secondary to umbilical artery catheterization in the newborn. Radiology. 1980;134:60.

    Article  CAS  Google Scholar 

  3. Verheij G, Smits-Wintjens V, Rozendaal L, Blom N, Walther F, Lopriore E. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates. BMJ Case Rep. 2009;2009:bcr04.2009.1778.

    Article  Google Scholar 

  4. Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child. 1966;4:69–75.

    Article  Google Scholar 

  5. Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986;140:786–8.

    CAS  PubMed  Google Scholar 

  6. Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010;98:381–6.

    Article  Google Scholar 

  7. 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 

  8. Verheij GH, te Pas AB, Smits-Wintjens VE, Šràmek A, Walther FJ, Lopriore E. Revised formula to determine the insertion length of umbilical vein catheters. Eur J Pediatr. 2013;172:1011–5.

    Article  Google Scholar 

  9. 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 

  10. 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;32:604–7.

    Article  CAS  Google Scholar 

  11. Lean WL, Dawson JA, Davis PG, Theda C, Thio M. Accuracy of 11 formulae to guide umbilical arterial catheter tip placement in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2018;103:F364–9.

    Article  Google Scholar 

  12. Lean WL, Dawson JA, Davis PG, Theda C, Thio M. Accuracy of five formulae to determine the insertion length of umbilical venous catheters. Arch Dis Child Fetal Neonatal Ed. 2019;104:F165–9.

    Article  Google Scholar 

  13. Gupta AO, Peesay MR, Ramasethu J. Simple measurements to place umbilical catheters using surface anatomy. J Perinatol. 2015;35:476–80.

    Article  CAS  Google Scholar 

  14. Lopriore E, Verheij GH, Walther FJ. Measurement of the ‘shoulder-umbilical’ distance for insertion of umbilical catheters in newborn babies: questionnaire study. Neonatology. 2008;94:35–7.

    Article  Google Scholar 

  15. Sheta A, Kamaluddeen M, Soraisham AS. Umbilical venous catheter insertion depth estimation using birth weight versus surface measurement formula: a randomized controlled trial. J Perinatol. 2020;40:567–72.

    Article  Google Scholar 

  16. Kieran EA, Laffan EE, O’Donnell CP. Estimating umbilical catheter insertion depth in newborns using weight or body measurement: a randomised trial. Arch Dis Child Fetal Neonatal Ed. 2016;101:F10–5.

    Article  Google Scholar 

  17. Efron B, Tibshirani R. Improvements on cross-validation: The .632+ bootstrap method. J Am Stat Assoc. 1997;92:548–60.

    Google Scholar 

  18. Allen DM. The relationship between variable selection and data augmentation and a method for prediction. Technometrics. 1974;16:125–7.

    Article  Google Scholar 

  19. Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927;22:209–12.

    Article  Google Scholar 

  20. Simanovsky N, Ofek-Shlomai N, Rozovsky K, Ergaz-Shaltiel Z, Hiller N, Bar-Oz B. Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol. 2011;21:1882–6.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Joshua Goss, Ph.D. and the Yale University ITS department for developing the UmbiCalc mobile app, as well as Hyung Paek, MD and Andrew Loza, MD, Ph.D. for their contribution to creating the EMR-based length estimation tool. Mobile app access: UmbiCalc is available for free on the Apple App Store and Google Play Store for iPhone and Android users, respectively.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    Christina J. Tambasco, Veronika Shabanova, Steven M. Peterec & Matthew J. Bizzarro

Authors
  1. Christina J. Tambasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veronika Shabanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven M. Peterec
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew J. Bizzarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CT primarily conceptualized and designed the study, collected and interpreted data, drafted the primary version of the paper, critically reviewed and revised subsequent drafts, and approved the final submitted version. VS assisted in designing the study, created the statistical models and performed all statistical analysis, critically reviewed and revised several drafts of the paper, and approved the final submitted version. SP assisted in designing the study, critically reviewed and revised several drafts of the paper, and approved the final submitted version. MB assisted in conceptualizing and designing the study, assisted with data collection, critically reviewed and revised several drafts of the paper, and approved the final submitted version.

Corresponding author

Correspondence to Christina J. Tambasco.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tambasco, C.J., Shabanova, V., Peterec, S.M. et al. A novel and accurate method for estimating umbilical arterial and venous catheter insertion length. J Perinatol 41, 1633–1637 (2021). https://doi.org/10.1038/s41372-021-01121-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-021-01121-7

Search

Advanced search

Quick links