A new technique for transumbilical insertion of central venous silicone catheters in newborn infants
D Haumont (Dominique Haumont@stpierre-bru.be), V Gouder de Beauregard, I Van Herreweghe, G Delanghe, R Ciardelli, E Haelterman
Department of Neonatology and Paediatrics, Saint-Pierre University Hospital, Free University of Brussels, BelgiumKeywords Central venous catheter, Umbilical catheter, Parenteral nutrition, Preterm-neonate Correspondence D Haumont, Department of Neonatology, Saint-Pierre University Hospital, Rue Haute, 322 B 1000 Brussels, Belgium. Tel: + 32 2 5354226 | Fax: + 32 2 5354563 | Email: Dominique Haumont@stpierre-bru.be Received 4 October 2007; revised 11 January 2008; accepted 17 March 2008.DOI:10.1111/j.1651-2227.2008.00786.x
Abstract Aim: A new technique allowing placement of umbilical silicone venous catheters (USVC) is described and compared with percutaneous silicone venous catheters (PSVC). Methods: Data were retrospectively recorded for 198 infants with USVC and 141 infants with PSVC. Results: Overall rate of complications was low and comparable in both groups: thrombosis 1.2%, catheter-relatedsepsis 3.5% and mechanical obstruction 5%. Conclusion: A new device allows safe introduction of silicone catheters into the umbilical vein.
The percutaneous silicone venous catheter (PSVC) is the preferred small-diameter central venous access in preterm infants (1). The umbilical vein is also a commonly used and easily accessible central venous route. However, because of a significantincidence of thrombosis, the polyurethane or polyvinyl chloride umbilical catheters are not suitable for long-term use (2,3). Silicone catheters lack stiffness for direct umbilical insertion. Therefore, we designed a new device for the introduction of the silicone catheter into the umbilical vein. The concept is shown in Figure 1 (ref.2184.01, Vygon). A rigid introducer serves as guide for advancing thesilicone catheter into the umbilical vein. The umbilical silicone venous catheter (USVC) is inserted under classical conditions of sterile umbilical catheterisation. The silicone catheter and the easy-lock connection system are flushed with saline. One of the three introducers is chosen according to the required catheter insertion distance and flushed with saline too. The silicone catheter isinserted and pushed forward into the introducer 1–2 mm ahead of its distal end. A haemostat forceps is gently clamped at the proximal end of the introducer and will stop the catheter from moving. The introducer with the silicone catheter in his lumen is now inserted and advanced into the umbilical vein. The haemostat forceps is removed. After the introducer is advanced the appropriate distance, thesilicone catheter is disconnected from the easylock infusion system. The introducer is carefully withdrawn and the catheter maintained in place by pushing it forward with a nontoothed forceps, similar to the percutaneous insertion. The silicone catheter is connected again with the infusion system and the tip position adjusted if needed. The position of the silicone catheter is verified by X-rays. Ifthe catheter tip is not in the correct position (i.e. in the portal vein), it is promptly removed and the percutaneous route is used.
The catheter position is documented again 1 or 2 days later by echocardiography and eventually adjusted. Indeed, X-rays alone can be misleading for evaluation of catheter placement (4). Echocardiography is repeated 1 or 2 days before removal to excludethrombosis. The patients with an umbilical line undergo abdominal echography before discharge in order to verify the portal and deep venous circulation. All newborn infants admitted in the NICU of Saint-Pierre University Hospital between January 2002 and December 2005 and who underwent central silicone catheterisation were included in this study. Data on catheter complications were retrospectively...