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Updated: Feb 18, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice
Daragh Finn1,2, Hannah Kinoshita3, Vicki Livingstone4
1Department of Paediatrics and Child Health, University College Cork, Wilton, Cork, Ireland. daraghfinn@gmail.com.
Insights
An educational initiative did not improve the accurate placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) in very preterm infants. Current methods for determining optimal insertion depth remain suboptimal, necessitating further evaluation of new techniques.
Area of Science:
- Neonatal care
- Medical education
- Patient safety
Background:
- Accurate placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is critical for very preterm infants.
- An educational initiative was implemented to improve the correct placement of these devices.
Purpose of the Study:
- To assess the impact of an educational intervention on the accuracy of ETT and UC placement in infants under 32 weeks gestational age.
Main Methods:
- A pre-post study design evaluated radiological placement of ETTs and UCs within 72 hours of birth.
- The intervention included audit feedback, anatomical guides for UCs, and weight-based depth calculations for ETTs.
Main Results:
- No significant difference in accurate placement was observed post-intervention for ETTs (50% vs. 47%), umbilical arterial catheters (UACs) (40% vs. 43%), or umbilical venous catheters (UVCs) (14% vs. 23%).
- The study included 211 infants, with 157 in the pre-education and 54 in the post-education groups.
Conclusions:
- Educational efforts did not significantly improve the initial insertion accuracy of ETTs, UACs, and UVCs.
- Suboptimal placement rates indicate a need for evaluating novel methods for determining optimal device positioning.
Background:
Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants.
Methods:
A pre-post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA) was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period.
Results:
During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%).
Conclusion:
Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.
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