How long can a Umbilical Artery line and an Umbilical Venous Line be used in an ELBW neonate when PICC line is not available. Various centers follow different protocols. Your views please

I think UVC can stay for 10 to 14 days, some stretch for a few more days. With rapid escalation of feeding regime, most don't stay this long. UAC is even removed much earlier. In LMICs, UVCs still remain a large part of standard of care due to cost with PICC

We typically will leave UVC in for 7-10 days then PICC. UAC can be left in for 7 days, ideally just 3-4 days depending on course of illness

The ideal time is the day before you were going to get a line infection from leaving it in. 7-10 days is a good range, but sooner if you can do without it. But in some ELBWs the ideal has to be thrown out the window. I am especially thinking of the 22-23 week or <500g babies where feeds cannot be advanced so fast and peripheral sites for PICC replacements are minimal to none. What then? 21 days if you must or longer if you need the central access and no other alternative.

We leave the UVC no more than 10 days, according to the Catheter Clinic, and the UAC no more than 4 days, according to clinical evolution.

I would say our standard is 5-7 days, can be up to 10 days if needed. We have on rare and desperate occasions left a UAC for 2-3wks - usually in the nanoprems where other IV access/skin integrity is super challenging... of course with escalating infection/thrombosis risk but sometimes chatline may be all we have...

in our unit, we use to take the UVC off at the fifth day. The arterial at third day. If we don’t have the opportunity to insert a PICC, then the UVC could be until the 10th day but all the staff get nervous 😬

5 days for UAC, max 10 days for UVC

Our routine use of UAC and UVC is 7 days. We leave UVC longer in some cases. We go to 10 days if needed and occasionally to 14 days with UVCs. We have not seen any higher complication rates with 7 days vs 10 days.

Naveed Hussain

University of Connecticut/ Connecticut Children's NICU.

Thanks for all your inputs. Good to know that there are no strict guidelines. Do you all heparinize these lines especially for ELBW and 25 weeke

rs

We usually leave UVC no more than 6-7 days and UAC no more than 4 days.

The problem comes when the UVC is malpositioned (intrahepatic or low position).... what do you do in this cases?

11 hours ago, Mohan said:

Do you all heparinize these lines especially for ELBW and 25 weeke

We do!

Only for UAC

UVC routine for 5-7days, median 5 days. Max 14 days.

This is a matter of prudential judgement. Of course these lines should come out, when they are no longer needed. The sooner the better but this varies with the clinical condicion of the baby, gestacional age, feasability of placing a PICC etc. One issue of UVC lines is that they tend to migrate, so close follow up specially with ultrasound is necessary. Thank you for your comments

UAC 10 days

UVC 14 days

obviously might need to stay longer for either line based on clinical need

In our unit

UAC 5 days

UVC - 7 to 10 days

KSAMC - MCH - NICU Madina Saudi Arabia

CVC max 6-7 days