A New Method of Umbilical Catheter Securement Is Associated with Significantly Lower Rates of Malposition

Background:

Introduction: Umbilical catheters (UCs) are vital to NICU care for monitoring and ensuring a reliable route for nutrition and medication. They are pain-free and provide central access. On average, half of UCs migrate to malposition using standard adhesive methods of securement, and migration leading to malposition can cause cardiac tamponade, pericardial effusion, and thrombus. Another risk is infection, which is a concern for given the need for proper umbilical desiccation to minimize infection risk. Current methods for securing UCs often leave the insertion site uncovered for this purpose but potentially allow bacterial introduction from touching during infant care and from diapers. The goal of this study was to measure the rates of migration leading to malposition using LifeBubble (Figure 1), a method of securing umbilical catheters.

Methods:

Methods: A retrospective concurrent chart review at a single Level IV NICU (Oregon Health & Science University) was performed on infants requiring UCs (UAC, umbilical arterial catheter; UVC, umbilical venous catheter) that were secured either using a LifeBubble (LB) or usual adhesive securement (Adhesive Control, AC) during the 2019-2021 epoch. Inclusion criteria included infants >1kg with the need for umbilical catheters. Exclusion criteria included infants who weighed <1 kg, those who were deceased or transferred out of the NICU prior to discontinuing the catheter. The catheters were removed either due to malposition or at end of use. Outcome measures were 1) the proportion of UCs that moved one vertebral body or more as determined by radiography and 2) the proportion that were removed due to malposition as determined on radiography. Results were analyzed using Wilcoxon rank sum or Pearson chi square tests.

Results:

Results: A total of 159 patients were included for review, 58 LB and 61 LBC. Comparing demographics, there were significantly different rates of congenital heart disease diagnoses in the LB versus AC group (47% vs 29%, p=0.05) and a trend towards significantly different birth weights between groups (Table1). There were a total of 106 UCs in the AC group (57 UVC, 49 UAC) and 89 in the LB group (54 UVC, 35 UAC). When comparing LifeBubble to the control group, there was significantly less UC migration of one vertebral body or greater i(12% vs 52%: p=0.00001) (Table 2), a significant reduction in UVC migration (5.6% vs 44%; p=0.00001) and importantly, a significant reduction in UVC migration leading to discontinuation (5.6% vs 39%; p=0.00008). While UAC migration and discontinuation was less in the LB versus the AC group (11.4% vs 29% 0% vs 7.4%) these findings were not significant. There were no CLABSIs in either group.

Conclusion:

Conclusion: This new method of umbilical catheter securement was associated with a statistically significant reduction in rates of umbilical catheter movement resulting in discontinuation due to malposition.