Application of bedside real-time ultrasound in umbilical vein catheterization of critically ill neonates

Objective To explore the application value of bedside real-time ultrasound in umbilical vein catheterization of critically ill neonates.

Methods A total of 126 neonates with umbilical vein catheterization were enrolled, and 75 neonates from April to December 2019 were designed as control group, the other 51 neonates from January 2020 to January 2021 were designed as study group. Blind insertion method for catheterization and the standard chest abdominal X-ray localization were performed in the control group; the bedside ultrasound guided umbilical vein catheterization was performed in the study group, and localization based on catheter end at the intersection of the inferior vena cava and right atrium was performed. The success rate of catheterization by one time, the average use time of umbilical vein catheter, the causes of failure in umbilical vein catheterization and the incidence of complications were compared between the two groups.

Results The success rate of catheterization by one time and the median use time of catheter were 82.35% and 5 days in the study group, which were significantly higher than 65.33% and 4 days in the control group (P < 0.05). The extubation rate due to failure in catheterization was 17.65% in the study group, which was significantly lower than 34.67% in the control group (P < 0.05). The planned extubation rate was 72.55% in the study group and 56.00% in the control group, and there was no significant difference between two groups (P>0.05). The extubation caused by failure in catheterization was mainly due to the umbilical vein catheterization entering the branch of the portal vein outside the anatomical pathway, and there were 20 cases (26.67%) in the control group and 6 cases (11.76%) in the study group, which showed a significant between-group difference (P < 0.05). There were 7 cases (9.33%) with adverse complications in the control group and 4 cases (7.84%) in the study group, but no significant between-group difference was observed (P>0.05). In the cases with successful catheterization in both groups, the tip of the catheter was mainly located at 0 to 1 cm above the diaphragm; in the control group, 7 cases (9.33%) had catheter tips located below the diaphragm, and 1 case (1.33%) had catheter tip located greater than 1 cm above the diaphragm. The tip of the successfully inserted catheter in both groups were mainly corresponded to the T₇ to T₉ vertebral bodies, and there was no significant difference between two groups (P>0.05).

Conclusion Compared with the traditional blind insertion method for catheterization, bedside real-time ultrasound guided umbilical vein catheterization has a higher success rate of catheterization by one time, longer average use time, a lower rate of extubation due to failure in catheterization, and features of non-invasive manipulation and radiation free. Umbilical vein catheterization is prone to displacement at 48 hours after surgery; when the end of the catheter shifts, ultrasonic localization is more accurate than the standard X-ray localization.