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Umbilical cath migration

Jennifer

By Jennifer
in practical procedures

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Vicky Payne Community Regular

Vicky Payne

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So the first thing is accuracy of X-rays at determining tip position and if the tip has genuinely migrated.

the second would be securing and fixation as @Stefan Johanssonhighlights above. Some places place a stitch at the base of the cord as well so that as the cord shrinks and detaches, the catheter is till secure. Obviously this depends on how long the catheter stays in for. 
 

then third would be considering nursing aspects like handling, cuddles etc how much is the line under tension etc 

What we are seeing more of is central line extravasations- including abdominal extravastions of PN via UVCs.
Anyone else experiencing this? Could it be related to PN composition? 

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Nathan Sundgren Enthusiast

Nathan Sundgren

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I feel like we more often see migration IN. We do suture in and even suture to the cord but still see the migration.  I would at least look at the “LifeBubble” product at Novonate.com. It has some evidence by abstracts of reducing migration problems. We haven’t purchased but have thought about it. 
https://www.novonate.com   

 

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cmcdermott Apprentice

cmcdermott

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While the catheters are sutured and a bridge using tape or a commercial device is used when the infant is nursed in high humidity there are potential problems.  Checking the position once a day is inadequate when in humidity the tape comes apart unless it is regularly checked and pressed together again (if you can understand what I mean).  At each procedure, nursing cares, disturbance of the baby a quick glance at the line ensuring the tape is adherent  is ideal.  Making sure like we do with chest drains that there is no pull on the line is also important.  I have heard of an adhesive produce that is available for PICCs but hasn't been tested in neonates.  Would something like that be an option for the future?

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Jennifer Apprentice

Jennifer

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On 11/19/2021 at 12:34 AM, Mark Davies said:

the UVC tips move even if the the UVC line does not move in relation to the umbilicus (i.e., securely sutured in place)

UVCsMove.JPG

Excellent Mark for identifying this paper.

On 11/18/2021 at 8:58 AM, cmcdermott said:

While the catheters are sutured and a bridge using tape or a commercial device is used when the infant is nursed in high humidity there are potential problems.  Checking the position once a day is inadequate when in humidity the tape comes apart unless it is regularly checked and pressed together again (if you can understand what I mean).  At each procedure, nursing cares, disturbance of the baby a quick glance at the line ensuring the tape is adherent  is ideal.  Making sure like we do with chest drains that there is no pull on the line is also important.  I have heard of an adhesive produce that is available for PICCs but hasn't been tested in neonates.  Would something like that be an option for the future?

Do you what that is called for PICCs? I asked RN and they say "Tegaderm", "Statlock". Are they right?

On 11/18/2021 at 8:58 AM, cmcdermott said:

While the catheters are sutured and a bridge using tape or a commercial device is used when the infant is nursed in high humidity there are potential problems.  Checking the position once a day is inadequate when in humidity the tape comes apart unless it is regularly checked and pressed together again (if you can understand what I mean).  At each procedure, nursing cares, disturbance of the baby a quick glance at the line ensuring the tape is adherent  is ideal.  Making sure like we do with chest drains that there is no pull on the line is also important.  I have heard of an adhesive produce that is available for PICCs but hasn't been tested in neonates.  Would something like that be an option for the future?

What is the called for PICCs? RNs here do not seem to know that

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carlosaldana Apprentice

carlosaldana

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Thank you Mark for the interesting paper. We also see migration of  UVC's is common. specially inward migration. Since many babies are on NCPAP, I don't know if the expected increase in the abdominal pressure, could have something to do with this. It is necessary to check the tip of the catheter periodically, preferably by ultrasound.

How many days you keep the UVC in place? 

greetings. I added another paper 

 

migration uvc.pdf

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Mark Davies Rookie

Mark Davies

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Posted

Study of movement of umbilical venous catheters over time

First published: 28 May 2018
 

 

https://onlinelibrary.wiley.com/doi/10.1111/jpc.14073

3 hours ago, carlosaldana said:

Thank you Mark for the interesting paper. We also see migration of  UVC's is common. specially inward migration. Since many babies are on NCPAP, I don't know if the expected increase in the abdominal pressure, could have something to do with this. It is necessary to check the tip of the catheter periodically, preferably by ultrasound.

How many days you keep the UVC in place? 

greetings. I added another paper 

 

migration uvc.pdf 312.42 kB · 0 downloads

thanks Carlos

 

we leave UVCs in place from a few days to, usually, a maximum of 14. Wil depend how desperate we are to maintain skin integrity and/or how readily a PICC can be inserted.

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