168 - Central Line Malposition Among Critically Ill Neonates

Poster Number: 168
Publication Number: 168.331

Michelle H. Lucena, The Children's Hospital at Montefiore, Verona, NJ, United States; Mark C.. Liszewski, Montefiore Medical Center and the Children’s Hospital at Montefiore, Bronx, NY, United States; Mimi Kim, Albert Einstein College of Medicine, Bronx, NY, United States; Xianhong Xie, Albert Einstein College of Medicine, Bronx, NY, United States; Mariam LaTuga, Albert Einstein College of Medicine, Bronx, NY, United States

Background: Central lines in the Neonatal Intensive Care Unit (NICU) are used to administer medication, assess hemodynamics, and provide nutrition. Incorrectly positioned central lines are associated with complications. Central line malposition has been related to multiple factors, including prematurity and small-for-gestation-age status. The impact of provider experience on proper central line positioning is unknown.

Objective: We hypothesized that those providers with more NICU experience would have lower rates of malpositioned central lines.

Design/Methods: In this retrospective cohort study, neonates had central lines placed within the first ten days of life. Central lines included umbilical artery catheters (UAC), umbilical vein catheters (UVC), and peripherally inserted central catheters (PICC). Central line malposition was confirmed with thoracoabdominal radiography. The official radiology report was considered the standard. Residents' experience was coded in months during their Neonatology rotations. For fellows in Neonatal-Perinatal Medicine, the experience was the difference between the procedure date and fellowship start date plus the months during Residency. Among nurse practitioners (NPs) and physician assistants (PAs), years of experience were coded by subtracting the procedure date from the hire date. T-tests or Wilcoxon rank sum tests were used to compare continuous variables between groups, and Chi-square tests to compare categorical variables. Logistic regression models were fit to assess independent predictors of central line malposition.

Results: Between 2019-2021, 301 neonates had 616 central lines. Baseline characteristics are shown in Table 1. Of all central lines, 66% (405/616) were malpositioned with distribution as follows: UVC 49.1% (199/405), UAC 20.5% (83/405), and PICC 30.4% (123/405). Only the central line type was associated with malposition with a p-value of 0.002 (Table 2). No significant association between provider experience and central line malposition was demonstrated in logistic regression analysis (Table 3). We also monitored central line complications, which were present in 21.1% (130/616). Migration, defined as the change from the initial correct position within 48 hours, was the most common complication, accounting for 75% of the cases (98/130).

Conclusion(s): Malposition of central lines frequently occurred in the NICU and was associated with UVCs, but not years of experience. Migration was most common among UVCs. Since current methods to estimate insertion length are inaccurate, better techniques should be developed.