To develop a novel, rapid, and more accurate model for estimating umbilical arterial (UAC) and venous catheter (UVC) insertion length.
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.
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.
Our novel approach more accurately estimates UAC and UVC insertion length.
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Pignotti MS, Monciotti F, Frati P, Fineschi V. Hepatic laceration due to umbilical venous catheter malpositioning. Pediatr Neonatol. 2017;58:386–7.
Johnson JF, Basilio FS, Pettett PG, Reddick EJ. Hemoperitoneum secondary to umbilical artery catheterization in the newborn. Radiology. 1980;134:60.
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.
Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child. 1966;4:69–75.
Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986;140:786–8.
Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010;98:381–6.
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.
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.
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.
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.
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.
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.
Gupta AO, Peesay MR, Ramasethu J. Simple measurements to place umbilical catheters using surface anatomy. J Perinatol. 2015;35:476–80.
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.
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.
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.
Efron B, Tibshirani R. Improvements on cross-validation: The .632+ bootstrap method. J Am Stat Assoc. 1997;92:548–60.
Allen DM. The relationship between variable selection and data augmentation and a method for prediction. Technometrics. 1974;16:125–7.
Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927;22:209–12.
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.
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.
Conflict of interest
The authors declare no competing interests.
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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