Umbilical cath migration

[Jennifer]

Hi Everyone,

I am a resident at St. Francis. We are seeing too many UVC migration. Wondering why no device manufacturer is addressing this problem?

We have line monitoring protocol. Despite of that, we are putting ton of work.

Do you guys face similar problems?

[selvanr4]

i haven't seen many

[Stefan Johansson]

@Jennifer - how do you mean? That the position of the UVC tip changes over time?

[Jennifer]

Yes Dr. Johansson. The tip keeps moving out. We monitor every 24 hours but the tip keeps changing

[Dr.Lamiya]

We are secured the catheter with a suture.

[Stefan Johansson]

Like @Dr.Lamiya we also secure UAC/UVC's with a holding sutur. In addition, a "tape bridge" with Steristrip This works pretty well, nurses check positions daily, as nb of cm inserted at skin level.

@Jennifer check out the topic below, @gayle omansky posted some really nice fixation pictures there.

 

[Vicky Payne]

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? 

[Dr.Lamiya]

We saw  abdominal extravasations of TPN from UVC. But in our experience we saw it only in prematures. We have seen approximately 7-8 times from 1100 prematures in 5 years. And we saw this after some days with UVC. 

[Nathan Sundgren]

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   

 

[Stefan Johansson]

@Nathan Sundgren Novonate - that’s a cool startup!