Introduction: The umbilical venous catheter is a vital access device in neonatal intensive care units for preterm and critically ill infants. Correct positioning is crucial, as malpositioning can lead to severe complications. According to international guidelines, the position of the umbilical venous catheter tip must be assessed in real time; traditionally, the catheter is visualized with a thoracoabdominal X-ray, but one of the most effective and safest methods is therefore real-time ultrasound. Methods: This study compares real-time ultrasound and traditional X-ray methods for assessing umbilical venous catheter tip location in 461 cases. The rate of tip malposition was analyzed retrospectively. The secondary aim was to assess indwelling time of umbilical venous catheters and reasons of removal. Results: Real-time ultrasound tip location, found to be more reliable and efficient, demonstrated a significantly lower incidence of primary malpositioning compared to X-ray assessments (9.6 vs. 75.9%). The study also highlighted the association of real-time ultrasound with reduced catheter manipulation, fewer radiographs, and higher indwelling times of umbilical venous catheter. The multiple logistic regression showed a high probability of the central safe position of the umbilical venous catheter tip using real-time ultrasound tip location (odds ratio 29.5, 95% confidence interval: 17.4–49.4). Conclusion: The findings support the adoption of real-time ultrasound in clinical settings to enhance umbilical venous catheter placement accuracy and minimize associated risks. A minimal training investment is needed to attain the proficiency to visualize the umbilical venous catheters, offering a substantial advantage in terms of both cost-effectiveness for the procedure and enhanced patient safety.

1.
D’Andrea
V
,
Prontera
G
,
Rubortone
SA
,
Pezza
L
,
Pinna
G
,
Barone
G
, et al
.
Umbilical venous catheter update: a narrative review including ultrasound and training
.
Front Pediatr
.
2021
;
9
:
774705
.
2.
Nickel
B
,
Gorski
LA
,
Kleidon
TM
,
Kyes
A
,
DeVries
M
,
Keogh
S
, et al
.
Infusion therapy standards of practice, 9th edition
.
J Infus Nurs
.
2024
;
47
(
1S Suppl 1
):
S1
285
.
3.
Gibson
K
,
Sharp
R
,
Ullman
A
,
Morris
S
,
Kleidon
T
,
Esterman
A
.
Adverse events associated with umbilical catheters: a systematic review and meta-analysis
.
J Perinatol
.
2021
;
41
(
10
):
2505
12
.
4.
Elgendy
MM
,
Aly
H
,
Mohamed
MA
.
The incidence of pericardial effusion requiring intervention in infants with a history of umbilical catheter placement: the US national database
.
J Perinatol
.
2021
;
41
(
10
):
2513
8
.
5.
Bersani
I
,
Piersigilli
F
,
Iacona
G
,
Savarese
I
,
Campi
F
,
Dotta
A
, et al
.
Incidence of umbilical vein catheter-associated thrombosis of the portal system: a systematic review and meta-analysis
.
World J Hepatol
.
2021
;
13
(
11
):
1802
15
.
6.
Morag
I
,
Epelman
M
,
Daneman
A
,
Moineddin
R
,
Parvez
B
,
Shechter
T
, et al
.
Portal vein thrombosis in the neonate: risk factors, course, and outcome
.
J Pediatr
.
2006
;
148
(
6
):
735
9
.
7.
Hoellering
AB
,
Koorts
PJ
,
Cartwright
DW
,
Davies
MW
.
Determination of umbilical venous catheter tip position with radiograph
.
Pediatr Crit Care Med
.
2014
;
15
(
1
):
56
61
.
8.
Kishigami
M
,
Shimokaze
T
,
Enomoto
M
,
Shibasaki
J
,
Toyoshima
K
.
Ultrasound-guided umbilical venous catheter insertion with alignment of the umbilical vein and ductus venosus
.
J Ultrasound Med
.
2020
;
39
(
2
):
379
83
.
9.
Barone
G
,
Pittiruti
M
,
D’Andrea
V
.
Ultrasound-guided catheter tip location in neonatal central venous access. Focus on well-defined protocols and proper ultrasound training
.
J Pediatr
.
2022
;
247
:
181
.
10.
Pittiruti
M
,
Annetta
MG
,
D’andrea
V
.
Point-of-care ultrasound for vascular access in neonates and children
.
Eur J Pediatr
.
2023
;
20
.
11.
Scott
MV
,
Fujii
AM
,
Behrman
RH
,
Dillon
JE
.
Diagnostic ionizing radiation exposure in premature patients
.
J Perinatol
.
2014
;
34
(
5
):
392
5
.
12.
Rubortone
SA
,
Costa
S
,
Perri
A
,
D’Andrea
V
,
Vento
G
,
Barone
G
.
Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study
.
Ital J Pediatr
.
2021
;
47
(
1
):
68
.
13.
Ramasethu
JSS
.
MacDonald’s atlas of procedures in neonatology
. 6th ed.
Philadelphia, PA
;
2020
.
14.
Shukla
H
,
Ferrara
A
.
Rapid estimation of insertional length of umbilical catheters in newborns
.
Am J Dis Child
.
1986
;
140
(
8
):
786
8
.
15.
Barone
G
,
Pittiruti
M
,
Biasucci
DG
,
Elisei
D
,
Iacobone
E
,
La Greca
A
, et al
.
Neo-ECHOTIP: a structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates
.
J Vasc Access
.
2022
;
23
(
5
):
679
88
.
16.
Barone
G
,
Pittiruti
M
,
Prontera
G
,
Ancora
G
,
D’Andrea
V
.
A novel neonatal protocol for Safe Insertion of Umbilical Venous Catheters (SIUVeC): minimizing complications in placement and management
.
J Vasc Access
.
2024
:
11297298241236220
.
17.
Upadhyay
J
,
Basu
S
,
Srivastava
Y
,
Digal
KC
,
Shubham
S
,
Grover
R
, et al
.
Agitated saline contrast to delineate central venous catheter position in neonates
.
J Perinatol
.
2021
;
41
(
7
):
1638
44
.
18.
Kieran
EA
,
Laffan
EE
,
O’Donnell
CP
.
Positioning newborns on their back or right side for umbilical venous catheter insertion
.
Acta Paediatr
.
2016
;
105
(
10
):
e443
7
.
19.
D’Andrea
V
,
Prontera
G
,
Pinna
G
,
Cota
F
,
Fattore
S
,
Costa
S
, et al
.
Umbilical venous catheter: focus on proper indication and proper securement
.
J Pediatr
.
2024
;
266
:
113884
.
20.
Cao
J
,
Zhang
Y
,
Yin
Y
,
Liu
Y
.
Accuracy of chest radiography compared to ultrasound for positioning the umbilical venous catheter in neonates: a meta-analysis and systematic review
.
J Vasc Access
.
2023
;
24
(
5
):
1051
60
.
21.
Sulemanji
M
,
Vakili
K
,
Zurakowski
D
,
Tworetzky
W
,
Fishman
SJ
,
Kim
HB
.
Umbilical venous catheter malposition is associated with necrotizing enterocolitis in premature infants
.
Neonatology
.
2017
;
111
(
4
):
337
43
.
22.
Henderson
RDE
,
Padash
S
,
Adams
SJ
,
Augusta
C
,
Yi
X
,
Babyn
P
.
Neonatal catheter and tube placement and radiographic assessment statistics in relation to important anatomic landmarks
.
Am J Perinatol
.
2024
;
41
(
S 01
):
e2299
306
.
23.
Rajaraman
N
,
Gowda
H
.
Does the use of point of care ultrasound (POCUS) improve umbilical venous catheter (UVC) positioning in neonates
.
Arch Dis Child
.
2024
:
2023-326653
. archdischild-2023-326653.
24.
Kaur
A
,
Manerkar
S
,
Patra
S
,
Kalamdani
P
,
Kalathingal
T
,
Mondkar
J
.
Ultrasound-guided umbilical venous catheter insertion to reduce rate of catheter tip malposition in neonates: a randomized, controlled trial
.
Indian J Pediatr
.
2022
;
89
(
11
):
1093
8
.
25.
D’Andrea
V
,
Prontera
G
,
Cota
F
,
Russo
R
,
Barone
G
,
Vento
G
.
Real-time ultrasound tip location reduces malposition and radiation exposure during epicutaneo-caval catheter placement in neonates
.
Am J Perinatol
.
2023
.
26.
D’Andrea
V
,
Cascini
V
,
Russo
R
,
Perri
A
,
Prontera
G
,
Ancora
G
, et al
.
The role of ultrasound in epicutaneo-caval catheter insertion in neonates: systematic review, meta-analysis and future perspectives
.
Diagnostics
.
2023
;
13
(
17
):
2850
.
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