765 - COMPARISON OF ULTRASOUND-GUIDED UMBILICAL VENOUS CATHETER INSERTION WITH CONVENTIONAL METHOD – A RANDOMIZED CONTROLLED TRIAL

Ultrasound (USG) can be used in neonates to manipulate and place the umbilical catheter in correct position. Though chest radiograph (CXR) is the gold standard, a non-invasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician.

Objective:

The primary objective was to compare the failure rate of USG-guided umbilical venous catheter insertion with the conventional method. The secondary objective was to determine the sensitivity and specificity of USG in determining the tip position as compared to CXR.

Design/Methods:

The neonates born between 25-42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit between July 2020 to July 2022, were randomized in two weight-based strata: ≤1200 and > 1200 gms.  Blind umbilical venous catheter insertion was done in control group while USG guided insertion was done in intervention group.

Results: Out of 112 enrolled neonates, 58 were in USG-guided group and 54 in the blind group. There was no significant difference in failure rate between the intervention and control groups [20% vs 29% (RR - 0.69, 95% CI-0.36-1.33, p value= 0.27)]. The sensitivity and specificity of USG in locating tip position was 97% and 46.8%, respectively. The median duration of time taken for USG to detect the tip position was 8 minutes (IQR 5.5-12 min) and for CXR was 37 minutes (IQR 33- 44 min).

Conclusion(s):

In our study, USG reduced the failure rates during the insertion of umbilical catheters. Though it was not statistically significant, it is clinically relevant. Thus, USG is a safe, noninvasive substitute to CXR in NICUs equipped with portable USG for guiding UVC insertion.