Related Experiment Videos
Evaluation of umbilical catheter and tube placement in premature infants
L D Narla1, M Hom, G K Lofland
1Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
Insights
Radiologists ensure proper placement of umbilical, endotracheal, and nasogastric tubes in premature infants. Accurate positioning prevents serious complications, improving infant outcomes.
Area of Science:
- Neonatal imaging
- Pediatric radiology
- Medical device placement
Background:
- Premature infants often require umbilical arterial/venous catheters, endotracheal tubes, and nasogastric tubes.
- Radiologists are essential for verifying correct placement and identifying complications associated with these devices.
Purpose of the Study:
- To outline ideal positioning for common catheters and tubes in premature infants.
- To highlight potential malpositions and associated complications.
Main Methods:
- Review of established guidelines for optimal placement of neonatal devices.
- Description of common malpositions and their radiographic recognition.
- Cataloging of potential complications resulting from incorrect placement.
Main Results:
- Ideal placement: umbilical venous catheter in right atrium, umbilical arterial catheter between T-6/T-10 or L-3/L-5, endotracheal tube 1.5 cm above carina, nasogastric tube in stomach.
- Malpositions can occur in major vessels or main stem bronchi.
- Complications include extraluminal placement, thrombi, aortic aneurysm, subglottic stenosis, granuloma, and organ perforation.
Conclusions:
- Accurate radiologic assessment of catheter and tube placement is critical for neonatal care.
- Understanding ideal positions and potential complications aids in preventing adverse events in premature infants.
Abstract:
Umbilical arterial and venous catheters, endotracheal tubes, and nasogastric tubes are routinely used in treating premature infants, and radiologists play a critical role in evaluating proper catheter and tube placement and recognizing potential complications. Ideally, an umbilical venous catheter should be positioned in the right atrium; an umbilical arterial catheter, between T-6 and T-10 (high position) or between L-3 and L-5 (low position); an endotracheal tube, 1.5 cm above the carina, with the infant's head in a neutral position; and a nasogastric tube, in the body of the stomach. Catheters and tubes can be malpositioned in a variety of vessels and the main stem bronchi, respectively. Complications include extraluminal placement of catheters (which can result in death), thrombi in the aorta and pulmonary artery, aortic aneurysm, subglottic stenosis, intubation granuloma, and perforation of the esophagus and stomach.