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Indian Pediatr 2019;56: 607 |
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Umbilical Venous Catheter Position Formula: Best is yet to
Come!
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Jogender Kumar1
and Arushi Yadav2
1Department of Pediatrics,
PGIMER, and 2Department of Radiodiagnosis, Government Medical
College and Hospital;
Chandigarh, India.
Email: [email protected]
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Despite umbilical venous catheter (UVC) insertion being a common
procedure in the neonatal units, the ideal formula for an optimal
position is still an illusion for the neonatologists. The study by
Krishnagowde, et al. [1], recently published in Indian
Pediatrics [1], is a step forward in this direction. We have few
concerns, clarification of which will be useful for the readers.
1. The authors compared Shukla’s formula [2] (UVC
length inserted (in cm) = (birth weight×3+9)/2) +1) with their
proposed JSS formula (UVC length (in cm) = 6.5 + weight in kg) and
showed that Shukla’s formula has higher rates (65.5%) of ‘short of
length to an acceptable position’ as compared to JSS formula
(29.2%). Calculating length of insertion with each formula, the
length of insertion is much more with Shukla’s formula as compared
to JSS formula; the difference widening as the weight of infant
increases. Thus, logically Shukla’s formula should have led to
deeper insertion as compared to JSS in this study. Shukla’s formula
has been earlier shown to lead to higher rates of over-insertion of
UVC; therefore, revised formula (UVC length inserted (in cm) =
(birth weight×3+9)/2) has been suggested [3].
2. The authors have used an anteroposterior (AP)
view X-ray for confirming the position of the tip of the UVC.
A recent study has shown that the radiograph has only moderate
accuracy in detecting the position of the tip of UVC [4]. The last
portion of the ductus venosus runs in the sagittal plane and,
therefore, it can be correctly visualized only in lateral view.
Moreover, rising concern of radiation exposure and increased
availability of the ultrasound machine makes the bedside
echocardiography the modality of choice. Ultrasound is shown to be
superior in localizing the exact position of the catheter and can
help in the real-time adjustment of the tip [4]. Therefore, the
studies comparing new formula with the existing one should use a
better standard (like echocardiography) to make the study more
robust. In the absence of the facility or skills for bedside
ultrasound, a lateral view should be combined with anteroposterior
to increase the diagnostic accuracy.
3. The authors did not mention the time interval
between the insertion of the catheter and chest radiograph
acquisition. The catheter migration after a few hours is not unusual
in the clinical practice, and delay in acquiring radiograph may show
increased rates of malposition [5].
References
1. Krishnegowda S, Thandaveshwar D, Mahadevaswamy M,
Doreswamy SM. Comparison of JSS formula with modified Shukla’s Formula
for insertion of umbilical venous catheter: A randomized controlled
study. Indian Pediatr. 2019;56:199-201.
2. Shukla H. Rapid estimation of insertional length
of umbilical catheters in newborns. Arch Pediatr Adolesc Med.
1986;140:786-8.
3. Verheij GH, te Pas AB, Smits-Wintjens VEHJ, Sramek
A, Walther FJ, Lopriore E. Revised formula to determine the insertion
length of umbilical vein catheters. Eur J Pediatr. 2013;172:1011-5.
4. Guimares AFM, Souza AACG de, Bouzada MCF, Meira
ZMA. Accuracy of chest radiography for positioning of the umbilical
venous catheter. J Pediatr (Rio J). 2017;93:172-8.
5. Hoellering AB, Koorts PJ, Cartwright DW, Davies
MW. Determination of umbilical venous catheter tip position with
radiograph. Pediatr Crit Care Med. 2014;15:56-61.
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