Accuracy of Shukla’s formula for depth of insertion of umbilical venous catheter
DOI:
https://doi.org/10.18203/2349-3291.ijcp20230688Keywords:
UVC, NICU, Shukla's formula, Depth of insertionAbstract
Background: The use of umbilical venous catheter (UVC) is an essential part of neonatal care allowing delivery of intravenous fluids, nutrition, and medication. It is important to know the position of the UVC tip accurately at the first attempt to prevent complications and minimize handling. We aimed to determine the precision and accuracy of Shukla’s formula developed to guide UVC placement and to evaluate the probability of UVC placement at desired radiological markings using weight-based Shukla’s formula.
Methods: This study was carried out at NICU in NRI medical college, a tertiary care center in Chinakakani, Andhra Pradesh, India. A prospective observational study was done from December of 2021 to September 2022. With an aim to study the accuracy of Shukla's formula in assessing the depth of insertion of UVC, depth was calculated and position of the tip of the catheter confirmed by x-ray.
Results: We have taken 138 neonates in our NICU unit with mean gestational age of 33.91 wks. and with mean birth weight of 1.91 kg. Out of 138 infants 99 had a successful ideal UVC placement using Shukla's formula. In reference to gestational age out 83 newborns in gestational age between 32-36 weeks 62 had ideal placement of UVC. In reference to birth weight ideal position of the UVC was seen in 73% of newborns.
Conclusions: Shukla’s formula provided a reasonably accurate probability of achieving ideal UVC position in most of our babies: accurate in 72%.
References
Santillanes G, Claudius I. Pediatric vascular access and blood sampling techniques. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier. 2019;19.
MacDonald MG. Umbilical vein catheterisation. Ch 28. In: MacDonald MG, Ramasethu J. Atlas of procedures in neonatology. 3rd Ed. Lippincott Williams and Wilkins. Philadelphia. 2002.
British Association of Perinatal Medicine. Use of Central Venous Catheters in Neonates A Framework for Practice. Revised 2018. London: BAPM. 2015. Available at: http://www.bapm.org/publications/documents/guidelines/BAPM%20CVC%20final%20Dec15.pdf. Accessed on 21st August 2022.
Landers S, Moise AA, Fraley JK, Smith EO, Baker CJ. Factors associated with umbilical catheter-related sepsis in neonates. American Journal of Disease in Childhood. 1991;145(6):675-80.
Lam HS, Li AM, Chu WC, Yeung CK, Fok TF, Ng PC. Mal-positioned umbilical venous catheter causing liver abscess in a preterm neonate. Biology of the Neonate. 2005;88(1):54-6.
Kim JH, Lee YS, Kim SH, Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology. 2001;219:645-650.
Sehgal A, Cook V, Dunn M. Pericardial effusion associate with an appropriately placed umbilical venous catheter. J Perinatol. 2007;27(5):317-9.
Department of Health. Review of the deaths of four babies due to cardiac tamponade associated with the presence of a central venous catheter. Department of Health, London. 2001. Available at: http://tinyurl.com/nzc7wlx. Accessed on 10 April 2022.
Pabalan MJ, Wynn RJ, Reynolds AM, Ryan RM, Youssfi M, Manja V et al. Pleural effusion with parenteral nutrition solution: an unisial complication of an “appropriately” placed umbilical venous catheter. Am J Perinatol. 2007;24(10):581-5.
Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child. 1966;41(215):69-75.
Lopriore E, Verheij GH, Walther FJ. Measurement of the 'shoulder-umbilical' distance for insertion of umbilical catheters in newborn babies: questionnaire study. Neonatology. 2008;94(1):35-7.
Ford S, Hagan J. Using surface anatomy measurements to place umbilical catheters. J Perinatol. 2016;36:161-2.
Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986;140(8):786-8.
Verheij GH, Pas AB, Smits-Wintjens VEHJ. Revised formula to determine the insertion length of umbilical vein catheters. Eur J Pediatr. 2013;172:1011-5.
Baker DH, Berdon WE, James LS. Proper localization of umbilical arterial and venous catheters by lateral roentgenograms. Pediatrics. 1969;43:34-9.
Fleming SE, Kim JH. Ultrasound-guided umbilical catheter insertion in neonates. J Perinatol. 2011;31:344-9.
Gomella TL, Cunningham MD, Eyal FG. Neonatology, management, procedures, on-call problems, diseases and drugs. 5th edn. Lange Medical books/ McGraw-Hill. 2005.
Lean WL, Dawson JA, Davis PG, Theda C, Thio M. Accuracy of five formulae to determine the insertion length of umbilical venous catheters. Arch Dis Child Fetal Neonatal Ed. 2019;104(2):F165-9.
Sheta A, Kamaluddeen M, Soraisham AS. Umbilical venous catheter insertion depth estimation using birth weight versus surface measurement formula: a randomized controlled trial. J Perinatol. 2020;40(4):567-72.
Akar S, Dincer E, Topcuoğlu S, Yavuz T, Akay H, Gokmen T et al. Determination of Accurate Position of Umbilical Venous Catheters in Premature Infants. Am J Perinatol. 2022;39(4):369-72.
Shareef AA, Mohammed RF, Kandla NA. Assessment of umbilical venous catheter insertion depth using Dunn and Shukla method. Curr Pediatr Res 2021;25(8):852-7.
Gupta AO, Peesay MR, Ramasethu J. Simple measurements to place umbilical catheters using surface anatomy. J Perinatol. 2015;35(7):476-80.