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Am J Perinatol 2024; 41(S 01): e2299-e2306
DOI: 10.1055/s-0043-1771051
Original Article

Neonatal Catheter and Tube Placement and Radiographic Assessment Statistics in Relation to Important Anatomic Landmarks

Robert D. E. Henderson 
1   Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Sirwa Padash 
1   Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Scott J. Adams 
1   Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Carolyn Augusta 
2   Department of Finance and Management Science, Edwards School of Business, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Xin Yi
1   Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Paul Babyn
1   Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
› Author Affiliations Funding None.
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Abstract

Objective Neonatal catheters and tubes are commonly used for monitoring and support for intensive care and must be correctly positioned to avoid complications. Position assessment is routinely done by radiography. The objective of this study is to characterize neonatal catheter and tube placement in terms of the proportion of those devices that are malpositioned.

Study Design Using an institutional dataset of 723 chest/abdominal radiographs of neonatal intensive care unit (ICU) patients (all within 60 days of birth), we assessed the proportion of catheters that are malpositioned. Many radiographs contained multiple catheter types. Umbilical venous catheters (UVCs; 448 radiographs), umbilical arterial catheters (UACs; 259 radiographs), endotracheal tubes (ETTs; 451 radiographs), and nasogastric tubes (NGTs; 603 radiographs) were included in our analysis.

Results UVCs were malpositioned in 90% of radiographs, while UACs were malpositioned in 36%, ETTs in 30%, and NGTs in just 5%. The most common locations in which UVCs were malpositioned were in the right atrium (31%) and umbilical vein (21%), and for UACs the most common malpositioned tip location was the aortic arch (8%). For the remaining tubes, 5% of ETTs were found to be in the right main bronchus and 4% of NGTs were found in the esophagus.

Conclusion A substantial proportion of catheters and tubes are malpositioned, suggesting that optimizing methods of catheter placement and assessment ought to be areas of focus for future work.

Key Points

  • Neonatal catheters are frequently malpositioned.

  • Most umbilical venous catheters need readjustment.

  • X-ray and ultrasound are important for assessment.

  • Catheter tips should be assessed in all X-rays.

Keywords

catheters - neonates - radiographs - position assessment

Ethical Statement

All data used in this work were exempted from review by the University of Saskatchewan Research Ethics Board.




Publication History

Received: 20 February 2023

Accepted: 12 June 2023

Article published online:
20 July 2023

© 2023. Thieme. All rights reserved.

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