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?

i haven't seen many

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

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

We are secured the catheter with a suture.

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.

 

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? 

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. 

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   

 

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

Yes we suture, bridge it. Our chief asked us to do monitor and we are noticing more. Thank you all for your insights. Dr. Johansson, Dr. Lamiya. Dr. Nathan, Dr. Vicky Payne. We will dif look into this Novonate this. Sounds interesting.

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?

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

13 hours ago, 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)

hi mark. Nice paper. Can u share the link to see this paper.

 

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)

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

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

Study of movement of umbilical venous catheters over time

Adam Hoellering,Didier Tshamala,Mark W Davies

First published: 28 May 2018

 

https://doi.org/10.1111/jpc.14073

 

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.

This is not entirely preventable suturing and securing needs standardisation. The smaller the baby the more difficult. We are preparing a new package for umbilical access which I have been working on for a few months. Currently taking feedback on what it should include and the education strategy. 

Anyone used this Novayas catheter? The company claims the catheter does not migrate at all..