Low-lying Umbilical Venous Catheters are not Always Associated with Increased Complications

Introduction: Umbilical venous catheters (UVCs) are frequently used for clinical care in neonatal intensive care units (NICUs). Umbilical venous catheters cannot always be positioned perfectly in the inferior vena cava, and low catheters have to be used until a more stable peripherally inserted central catheter can be placed after ruling-out early onset sepsis. There are concerns that low UVCs may be associated with complications such as infection, extravasation, and thrombosis. Objectives: To determine whether UVC complications were associated with (1) low positioning of the catheter tip and (2) the postnatal age at insertion. Methods: We examined a retrospective cohort of infants with UVCs in a tertiary NICU. Neonates with major congenital anomalies, hydrops fetalis, prenatally diagnosed cardiac arrhythmias, pericardial effusion, or ascites were excluded. The position of UVCs is considered as optimum if its tip is seen on radiographs at the level between 8th and 10th thoracic vertebrae (T8–T10), to be low if below T10, and high if above T8. The primary outcome was UVC-related complications resulting in early removal of catheter. We compared the rates of UVC-related complications resulting in removal of UVCs with tips in normal (T8–T10) vs low-lying (below T10) positions at the time of insertion. We also examined the impact of postnatal age, before or after 12 hours, and the frequency of the UVC-related complication. Results: Of the 919 eligible infants, UVC tips were located optimally in 433 (47%) and were low in 415 (45%). The UVC was positioned at an abnormally high position in 71 (8%) infants. Of the 919 infants, UVC-related complication was seen in 54 (5.9%) infants. Low-lying UVCs were removed due to complications in 27 of 415 (6.5%) compared with 20 of 433 (4.6%) optimally position catheters [adjusted odds ratio (aOR) = 1.16; 95% confidence interval (CI): (0.62–2.17)]. High-placed UVCs were associated with a higher rate of cardiac complications (aOR = 6.09, 95% CI [2.03–18.28]) compared with optimally position UVCs. There was also no difference in UVC-related complications between early and late insertion of UVC (6.3% vs 4.7%, p = 0.34). Conclusions: The frequency of complications and consequent need for removal did not differ in UVCs with a tip position traditionally perceived to be optimal or low or by the time of insertion after birth.