P0303 - A Novel Method of Securement for Umbilical Lines To Reduce Malposition Rates

Introduction

Umbilical catheterization is frequently needed for central access in critically ill patients in the NICU. Traditionally these lines are secured by suturing to the umbilical stump and using various adhesives. Despite these measures, malposition rates for umbilical lines have been described in the literature as upwards of 65%. Malpositioned umbilical venous catheters (UVCs) not only result in additional procedures, they are associated with complications such as pleural effusion, extravasation injuries, pericardial tamponade, cardiac arrhythmias, and thrombi. The purpose of our study was to assess malposition rates when using a novel method of securement known as the LifeBubble designed by Novonate (South San Francisco, CA).

Methods

This is a retrospective review of patients who underwent umbilical line catheterization securement with LifeBubble (Image 1) in the NICU at Lucile Packard Children’s Hospital at Stanford from April 2019 to January 2020. The primary outcome of the study was to determine the malposition rates of umbilical catheters (UCs) when using LifeBubble as a securement device. We included all neonates admitted to the NICU who had LifeBubble placed and excluded patients who had other documented securement measures, those who died within 5 days of life, and those who were transferred out of the NICU to undergo open cardiac surgery. Demographic data was gathered for all patients. Serial CXR images were reviewed to determine the position of UACs/UVCs throughout the life of the catheter; malposition was determined based upon review of imaging and chart documentation. Time to malposition was also studied. Additionally, a survey was distributed to the NICU staff who interacted with LifeBubble.

Results

Thirty-two patients were included in the study who had umbilical catheters secured with LifeBubble between April 2019 and January 2020. Mean gestational age of LifeBubble patients was 35 weeks ± 4.5 weeks with birth weight of 2340 g ± 945 g (Mean ± SD) (Table 1). Twenty-three UVCs and 22 UACs were placed, with 14 patients catheterized with both UAC and UVC (Table 1). Four UVCs were found to be malpositioned (17% of UVCs) and removed at an average of 102 hours (Table 1). No UACs were removed due to malposition. Of the NICU nurses involved in the use of LifeBubble who were surveyed (N=84), 93% found it was easy to use, protective, and secure, with 95% also reporting that it was quick to apply.

Conclusions

LifeBubble is a safe method of umbilical catheter securement which allows for physical protection of the stump-catheter interface, has a lower umbilical catheter migration rate compared to the literature, and is well received by nursing staff. Future aims include a case-control study to compare catheter malposition rates with LifeBubble compared to standard of care within our unit.