Anatomy of the Ductus Venosus, Umbilical Venous Catheterization
Conditions
Keywords
ductus venosus, umbilical venous catheter positioning, umbilical vein-ductus venosus angle, ultrasound assessment
Brief summary
The goal of this clinical trial is to learn if the ultrasound assessment of the angle formed between the terminal segment of the Umbilical Venous and the initial segment of the Ductus Venosus (DV)play a role in Umbilical Venous Catheterization (UVC). The main questions it aims to answer are: Can the Umbilical Venous-Ductus Venosus angle on Point-of-care ultrasonography improve the prediction and success of UVC placement in neonates ? The secondary aim was to assess the effectiveness of ultrasound-guided navigation with corrective maneuvers for correct UVC placement.
Detailed description
Umbilical venous catheterization are used in infants who are critically ill to ensure reliable central access, allowing for the administration of parenteral nutrition and medications. Catheterization of the umbilical vein involves numerous potential complications. A large proportion of these complications results from incorrect catheter positioning. Catheter tip may be malpositioned, with reported failure rates of up to 50%, which may be associated with an increased risk of complications. Thoracoabdominal radiography (TAR) has long been the standard approach for confirming catheter tip position. Clinical studies have consistently demonstrated discrepancies between radiologic and ultrasonographic evaluations in determining central catheter tip position. Point-of-care ultrasonography enables efficient vascular access and reliable assessment of catheter tip position. What more, we hope this approach aids in selecting appropriate corrective maneuvers, may reduce the number of insertion attempts. The primary aim of the ultrasonographic assessment of umbilical venous catheter positioning was to evaluate the anatomical course of the umbilical venous and the ductus venosus, as well as their influence on the correct placement of the catheter within the umbilical vein. The secondary objective was to evaluate the effectiveness of ultrasound-guided navigation combined with corrective maneuvers in achieving the correct placement of the UVC.
Interventions
DIAGNOSTIC_TESTUltrasound assessment of UV-DV angle
Ultrasound measurement of the umbilical vein-ductus venosus (UV-DV) angle in neonates undergoing umbilical venous catheter placement, with assessment according to catheter tip position.
DIAGNOSTIC_TESTUltrasound-guided corrective maneuvers for UVC placement
Real-time ultrasound-guided corrective maneuvers were performed to reposition umbilical venous catheters initially located in a low position, with advancement of the catheter toward the correct anatomical location.
Sponsors
Princess Anna Mazowiecka Hospital, Warsaw, Poland
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
1 Days to 3 Days
Healthy volunteers
No
Inclusion criteria
Neonates born at at ≥24 weeks of gestational age who required parenteral nutrition during the early postnatal period.
Exclusion criteria
Individuals with congenital gastrointestinal tract malformations, agenesis of the ductus venosus, or those delivered prior to 24 weeks of gestation were excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Umbilical Venous-Ductus Venosus Angle | within the first 72 hours of life | The obtuse angle (measured in degrees) between the terminal segment of the umbilical vein and the initial segment of the ductus venosus, assessed using point-of-care ultrasound. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of the umbilical venous-ductus venosus angle between low and high umbilical venous catheter positioning | within the first 72 hours of life | The umbilical vein-ductus venosus (UV-DV) angle measured by point-of-care ultrasound was compared between neonates with low-positioned and high-positioned umbilical venous catheters. |
| Success Rate of Ultrasound-Guided Maneuvers | within the first 72 hours of life | Proportion of participants with initially malpositioned umbilical venous catheters in whom correct catheter position is achieved after ultrasound-guided maneuvers |
| Causes of Umbilical Venous Catheter Malposition | within the first 72 hours of life | Frequency and type of identified causes of catheter malposition detected during ultrasound assessment |
Countries
Poland
Contacts
PRINCIPAL_INVESTIGATORKamil Gierek, M.D.
Department of Neonatology with Neonatal Intensive Care Unit, University Clinical Hospital in Rzeszów, Chopina 2, 35-055 Rzeszów, Poland
STUDY_CHAIRRenata Bokiniec, Prof. M.D.
Department of Neonatology and Neonatal Intensive Care Medical University of Warsaw, Karowa 2
Outcome results
None listed