Benjamin Kozyak, MD
Attending Physician, Cardiac Critical Care Medicine
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Maria Fraga, MD
Associate Professor of Pediatrics. Division of Neonatalogy
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Courteny Juliano, MD
Assistant Professor of Pediatrics
Kravis Children's Hospital and Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Shazia Bhombal, MD
Clinical Associate Professor of Pediatrics, Neonatal and Developmental Medicine
Stanford University School of Medicine, United States
Disclosure information not submitted.
David Munson, MD
Professor of Pediatrics
The Children's Hospital of Philadelphia & University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Erik Brandsma, MD
Associate Professor of Pediatrics
The Children's Hospital of Philadelphia & University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Jason Stoller, MD
Associate Professor of Pediatrics
The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
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Ankit Jain, MD PhD
Hospitalist Physician
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Russell Kesman, MD MSEd
Assistant Professor of Clinical Pediatrics
Yale University School of Medicine, United States
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Malorie Meshkati, MD
Assistant Professor of Pediatrics
Kravis Children's Hospital and Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Caroline Noh, MD MS
Fellow in Neonatology
Stanford University School of Medicine, United States
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Aaron DeWitt, MD
Assistant Professor of Clinical Pediatrics
Children's Hospital of Philadelphia, Pennsylvania, United States
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Andrew Costarino, MD MSCE
Professor of Anesthesiology & Critical Care Medicine
The Children's Hospital of Philadelphia & University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
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David Hehir
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
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Alan Groves, MBChB
Associate Professor of Pediatrics
University of Texas at Austin, Dell Medical School, United States
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Title: Real-time Ultrasound Guidance to Increase Success of Umbilical Venous Cannulation
Introduction: Central venous access is essential to the resuscitation of critically ill neonates. Umbilical venous cannulation is the most widely practiced approach to perinatal central access worldwide but has a failure rate of 25-50% and the insertion technique has not evolved in decades. Improving the success of this procedure would have broad implications, particularly where peripherally inserted central catheters are not easily obtained and in neonates undergoing cardiac surgery, in whom umbilical access facilitates administration of inotropes and blood products while sparing other vessels that may be essential for later cardiac interventions. We sought to use real-time, point-of-care ultrasound to achieve successful central umbilical venous cannulation in patients for whom traditional blind placement techniques had failed.
Methods: Case series, multicenter. In thirty-two neonates with congenital heart disease, who had failed umbilical venous catheter placement using traditional, “blind” techniques, real-time ultrasound-guidance and liver pressure were used to replace malpositioned umbilical venous catheters and achieve successful placement at the inferior cavoatrial junction. Rate of successful central umbilical venous cannulation and impact of postnatal age on placement were measured.
Results and Conclusions: In 32 patients with failed prior umbilical venous catheter placement, real-time ultrasound guidance was utilized to successfully “rescue” the line and achieve central position in 23 (72%). Attempts in the first 48 hours of life appeared to be more successful: 20 of 25 (80%) in the first 48 hours of life, versus 3 of 7 (43%) performed later. Prostaglandin therapy appeared to be associated with increased success. No association between patient weight or gestational age and successful placement was detected. Real-time ultrasound guidance has become standard of care for central venous line placement in children outside the neonatal period but is a new and emerging technique for umbilical vessel catheterization. In this early experience, we report that point-of-care ultrasound, together with liver pressure, can be used to rescue failed umbilical venous cannulation with a high rate of success. This represents a significant advance in this core neonatal procedure.