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UMBILICAL VEIN CATHETERIZATION UNDER ECG GUIDANCE

Department of Anesthesiology and Pain Medicine, and Neonatal ICU, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, T6G 2B7

INTRODUCTION

Umbilical venous catheters (UVC) are inserted and advanced blindly to a predetermined length from the umbilicus into the thorax region in newborns. The reported rates for UVC placed into the liver (occasionally the spleen) range from 20% to 37%.1 Radiographs are used routinely to confirm the positioning of UVC. This involves movement of neonates who are often critically ill, as well as radiation exposure. Using the same concept as for ECG confirmation of thoracic epidural catheter placement via the caudal space,2 this pilot study examines the potential value of confirming UVC in neonates using ECG.

METHODS

After IRB approval and consent, a conductive "Johans ECG" adapter was connected to UVC. A satisfactory tracing (lead II) was obtained (right arm lead connected to the adapter) when the UVC was filled with saline solution allowing the catheter tip to become a unipolar ECG electrode. The UVC was then advanced from the umbilical area until the tip reached the inferior vena cava (IVC) within the thoracic region, as demonstrated by appearance of normal sized QRS complexes with small P-waves. A small QRS indicated the catheter was below the diaphragm. The appearance of a tall positive P-wave indicated the tip was at the right atrium level. The UVC was then withdrawn until the P-wave size returned to normal. The final UVC position was later confirmed by x-ray.

RESULTS

Nine neonates were studied. The Figure shows typical ECG tracings when the UVC was placed in the liver, IVC, and right atrium, respectively. Three malpositioned catheters were detected (2 into liver and 1 into spleen). In one neonate, we were unable to obtain an ECG signal via the catheter despite the UVC in proper location as confirmed by x-ray.

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Based on these preliminary results, the insertion of UVCs can be guided by observing sequential and characteristic alterations in P waves and QRS complexes. Further studies will be warranted.

REFERENCES

1 Radiol Clin North America1999;37:1109–25.[Medline]

2 Anesth Analg.2002; 95:326–30.[Abstract/Free Full Text]

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