735 - Disposable Pressure Transducer to Identify Central Pressure Measurements in Umbilical Lines for Preterm and Term Infants in the Neonatal Intensive Care Unit

Poster Number: 735
Publication Number: 735.245

Carrie A. Moore, University of Louisville School of Medicine, Louisville, KY, United States; Lori A. Devlin, University of Louisville School of Medicine, Louisville, KY, United States; Cynthia Crabtree, University of Louisville School of Medicine, Louisville, KY, United States; Amanda C. Farris, University of Louisville, Norton Children's Medical Group, Louisville, KY, United States; Yana B. Feygin, University of Louisville School of Medicine, Louisville, KY, United States; Mst Sharmin Akter Sumy, University of Louisville School of Medicine, Louisville, KY, United States; Keri Marques, University of Louisville School of Medicine, Prospect, KY, United States

Background: PICC (peripherally inserted central catheter) lines are essential to neonatal care. Quality improvement initiatives have enhanced the safety of PICC line placement, but further efforts are needed to maximize safety. Inadvertent arterial placement is a serious complication, which may lead to compromised perfusion and an increased risk of arterial thrombosis. Chest radiographs are the standard for confirming placement, but methods for verifying placement in an artery vs. vein are lacking.

Objective: A disposable pressure transducer with a digital display has been used in central line placement in adults but has yet to be tested in infants. This pilot study was designed to assess the feasibility of using the transducer to determine a pressure difference between arterial and venous systems in infants admitted to a level IV neonatal intensive care unit.

Design/Methods: The transducer was attached to umbilical artery catheters (UAC) and umbilical venous catheters (UVC) to obtain a baseline pressure. Infants ≥23 weeks’ gestation with umbilical lines placed for clinical care from February to August 2022 were enrolled. The transducer was activated, calibrated, and attached to the umbilical catheter for measurement. Twenty-seven patients were enrolled, and 36 measurements obtained, 17 from UACs and 19 from UVCs. A reference point of 12mmHg was chosen to differentiate between arterial and venous pressures, hypothesizing that arterial pressures would be ≥12mmHg and venous pressures would be < 12mmHg. Infants were enrolled if x-ray confirmed proper positioning of umbilical catheters and if they had an English-speaking legal guardian. Infants were excluded if they had a poor arterial waveform on UAC tracing. Descriptive statistics were used to analyze continuous variables and were compared using a Mann-Whitney U Test.

Results: Of the measurements, 100% of the UACs were ≥12mmHg and 84% of the UVCs were < 12mmHg. The median device pressures for UACs and UVCs were 41mmHg (IQR 32-43mmHg) and 5mmHg (IQR 3-9mmHg) respectively (p-value < 0.0001). Of the 3 UVC readings outside the expected range, 2 of the 3 were double lumen catheters. Two of the 3 readings were infants with congenital anomalies (congenital heart disease and caudal regression syndrome).

Conclusion(s): This pilot study suggests that the disposable pressure transducer is likely safe and can identify a pressure difference between the arterial and venous systems in neonates. A cutoff pressure of 12mmHg appears to identify lines placed in the arterial system. This study serves as a foundation for further investigation of the device with PICC line placement.