Comparison of the insertion of umbilical vein catheter techniques

Aim: Umbilical catheters are frequently required in the management of severely ill neonates. Complications associated with umbilical catheterization may result from inappropriate positioning of the catheter. This study compares the methods of Dunn, Shukla and Modified Shukla in determining the appropriate insertion length of umbilical vein catheters. Materials and Methods: This prospective observational study was carried out in 121 newborns with umbilical venous catheter at the Karadeniz Technical University Neonatal Intensive Care Units divided into three groups according to umbilical venous catheter insertion formulas. Group 1 used Dunn nomogram of 41 members, Group 2 used Shukla Formula and Group 3 used Modified Shukla Formula of 40 members each. Catheter tip position evaluated with an antero-posterior chest radiograph after insertion of umbilical venous catheter. Ideal position of the umbilical venous catheter was defined as the catheter tip being visible between the 9th and 10th thoracic vertebra on an antero-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9th thoracic vertebra, and too low if the tip was below the 10th thoracic vertebra. The following neonatal data were collected: appropriate, inappropriate and abnormal placement. Ultrasound and Doppler ultrasound examinated weekly to rule out catheter-related complications was routinely performed in all neonates as long as the catheter inserted. Results: In the Shukla group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position against 40% (12/30) in the Modified Shukla group and %38 (11/29) in the Dunn group. However this difference was not statistically significant. High localized catheter rates %52 (15/29) in the Dunn group, %44 (14/32) in the Shukla group and %40 (12/30) in the Modified Shukla group; low localized catheter rates %10 (3/29) in the Dunn group, %3 (1/32) in the Shukla group and %20 (6/30) in the Modified Shukla group. However this difference was not statistically significant (p>0.05). Umbilical venous catheter related complications developed at two patients, thrombus in one and catheter-related blood stream infection in the other. Conclusion: The Shukla formula is more accurate in predicting the insertion length for umbilical venous catheters. The appropriate position of umbilical venous catheters is important for preventing complications. Complications associated with umbilical catheterization may avoidable by appropriate positioning of the catheter.