Migration of Central Venous Catheters in Neonates: A Radiographic Assessment
11 August 2015
04 November 2015
05 January 2016 (online)
Objective This study aims to determine the frequency that umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs) migrate into the cardiothymic silhouette after initial verification of correct placement.
Study Design This is a single-center, retrospective study in neonates in whom a PICC or UVC was placed. The frequency of catheter tip migration into the cardiothymic silhouette requiring catheter manipulation was determined radiographically at 1 and 24 hours, respectively, after insertion.
Results At 1 and 24 hours, 36 and 23% of UVCs (n = 41) migrated into the cardiothymic silhouette, respectively. At 1 and 24 hours, 23 and 11% of PICCs (n = 63) migrated into the cardiothymic silhouette, respectively. Migration was not associated with birth weight, weight at insertion, or postnatal age at insertion.
Conclusion UVCs and PICCs frequently migrate into the cardiothymic silhouette increase the risk for development of a pericardial effusion. Serial radiographic assessment of catheter tip location is needed to assess catheter migration within the first 24 hours of line placement.
- 1 Beardsall K, White DK, Pinto EM, Kelsall AW. Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem?. Arch Dis Child Fetal Neonatal Ed 2003; 88 (4) F292-F295
- 2 Nadroo AM, Lin J, Green RS, Magid MS, Holzman IR. Death as a complication of peripherally inserted central catheters in neonates. J Pediatr 2001; 138 (4) 599-601
- 3 Leipälä JA, Petäjä J, Fellman V. Perforation complications of percutaneous central venous catheters in very low birthweight infants. J Paediatr Child Health 2001; 37 (2) 168-171
- 4 Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002; 110 (1 Pt 1) 137-142
- 5 Warren M, Thompson KS, Popek EJ, Vogel H, Hicks J. Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization. Ann Clin Lab Sci 2013; 43 (2) 163-171
- 6 Onal EE, Saygili A, Koç E, Türkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe?. Paediatr Anaesth 2004; 14 (11) 953-956
- 7 Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol 2007; 27 (5) 317-319
- 8 Paster S, Middleton P. Roentgenographic evaluation of umbilical artery and vein catheters. JAMA 1975; 231 (7) 742-746
- 9 Yoder D. Cardiac perforation and tamponade: the deadly duo of central venous catheters. Int J Trauma Nurs 2001; 7 (3) 108-112
- 10 Sharpe E, Pettit J, Ellsbury DL. A national survey of neonatal peripherally inserted central catheter (PICC) practices. Adv Neonatal Care 2013; 13 (1) 55-74
- 11 Srinivasan HB, Tjin-A-Tam A, Galang R, Hecht A, Srinivasan G. Migration patterns of peripherally inserted central venous catheters at 24 hours postinsertion in neonates. Am J Perinatol 2013; 30 (10) 871-874
- 12 Baker DH, Berdon WE, James LS. Proper localization of umbilical arterial and venous catheters by lateral roentgenograms. Pediatrics 1969; 43 (1) 34-39
- 13 Coit AK, Kamitsuka MD ; Pediatrix Medical Group. Peripherally inserted central catheter using the saphenous vein: importance of two-view radiographs to determine the tip location. J Perinatol 2005; 25 (10) 674-676
- 14 Connolly B, Amaral J, Walsh S, Temple M, Chait P, Stephens D. Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs). Pediatr Radiol 2006; 36 (8) 845-850
- 15 Nadroo AM, Glass RB, Lin J, Green RS, Holzman IR. Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics 2002; 110 (1 Pt 1) 131-136
- 16 Fleming SE, Kim JH. Ultrasound-guided umbilical catheter insertion in neonates. J Perinatol 2011; 31 (5) 344-349
- 17 Ades A, Sable C, Cummings S, Cross R, Markle B, Martin G. Echocardiographic evaluation of umbilical venous catheter placement. J Perinatol 2003; 23 (1) 24-28
- 18 Pulickal AS, Charlagorla PK, Tume SC, Chhabra M, Narula P, Nadroo AM. Superiority of targeted neonatal echocardiography for umbilical venous catheter tip localization: accuracy of a clinician performance model. J Perinatol 2013; 33 (12) 950-953