Adverse events associated with umbilical vascular catheters in the NICU: a retrospective cohort study

 

Kim Gibson (1), Amber Smith (2), Rebecca Sharp (1), Amanda Ullman (3), Scott Morris (2), Adrian Esterman (1)

 

1. The University of South Australia, 2. Flinders Medical Centre, 3. The University of Queensland

 

Introduction

Umbilical catheters are associated with mechanical, infectious, and thrombotic adverse events (AEs), with 13% of umbilical venous catheters (UVCs) and 9% of umbilical arterial catheters (UACs) associated with an AE. Current international guidelines recommended limiting catheter dwell time to reduce the risk of AEs, yet other factors may also increase risk that warrant further investigation.

 

Aim 

To determine the incidence and risk factors for AEs (all cause, and individual types) associated with UVCs and UACs in the NICU.

 

Methods

A retrospective cohort study was conducted in an Australian NICU. Medical records, x-rays and electronic results were reviewed. Log binomial generalized linear models were used to estimate the incidence proportion (%), the Incidence Rate and the Incidence Risk Ratio.

 

Results

The dataset consisted of 236 infants with 245 UVCs and 249 UACs in 836 and 887 days of dwell time.

71% of UVCs were associated with an AE

44% of UACs were associated with an AE

Malposition on 1st x-ray: 60% of UVCs, 33% of UACs

2-2.6% clinical line sepsis (no CLABSI)

A dwell of ≥7 days significantly increased the risk for UVC tip migration and all UAC AEs.

Infants with a birth weight between 1000 - 2499 grams or born between 27-32 weeks’ gestation had a significantly reduced risk for all UAC AEs.

 

Conclusion

Ultrasound guidance may improve insertion success and limit the need for x-ray, catheter manipulation and replacement. Routine tip surveillance is necessary to monitor for UVC migration. The low umbilical catheter infection rate in this NICU may be due to insertion practices, the use of bacterial filters and infection prevention education rather than prolonged dwell time. Further investigation is required for why infants with a birth weight between 1000-2499 grams have reduced risk of an AE associated with UAC