Comparison of accuracy of ultrasound guided umbilical venous catheter insertion with standard technique in neonates admitted in neonatal intensive care unit - a randomised controlled trial

Umbilical venous catheters provide unique and easy central venous access in neonates. They are usually inserted based on a pre calculated depth of insertion. There are various methods to determine the depth of insertion. The position is confirmed with a radiograph. A common problem encountered with umbilical catheter insertion is catheter malposition. Malpositioned catheters are associated with various complications and warrant removal or repositioning. In current practice, with the increasing availability of point of care ultrasound, it is also being used to localize catheter tips. In this study, we are evaluating an ultrasound-guided technique to prevent catheter malposition, specifically portal vein cannulation. We propose to compare the accuracy of ultrasound-guided catheter insertion versus standard  procedure. In this technique, UV catheter is inserted under ultrasound guidance. As the catheter is being inserted, the tip will be localized with an ultrasound probe kept over the abdomen. At the level of portal sinus, if the catheter is advancing to the portal vein, instead of ductus venosus, pressure will be applied over the abdomen with the ultrasound probe. This makes a change in the alignment of the venous system that the portal vein gets occluded and ductus venosus comes in line with the sinus, thus guiding the catheter into ductus venosus and then IVC.

We also propose to look at the time taken for catheter insertion and incidence of central line associated blood stream infection and extravasation associated with both techniques. This study may help in developing a bedside technique to accurately insert UVC, thus minimizing chance of catheter malposition.