Interpretation of Umbilical Venous Catheter Position on X-ray: A Trainee’s Perspective

Background: As paediatric trainees working within a tertiary neonatal unit, we observed uncertainty amongst fellow trainees when assessing umbilical venous catheter (UVC) position on X-rays. This had two potential adverse consequences; the unnecessary removal of safely positioned lines and the continued use of malpositioned UVCs.

Objective: To analyse the accuracy of trainees’ interpretation of UVC placement on X-ray within our department.

Methods: Through ‘BadgerNet Neonatal’ we identified all patients undergoing UVC insertion within our department over a four-month period (n=83, images available in 78 cases). With a senior neonatal consultant, we retrospectively reviewed the accompanying X-ray images against British Association of Perinatal Medicine guidelines. Medical notes for 52 patients were available, allowing assessment of trainee interpretation of position at the time of insertion, and if any adjustments were made. Each image was categorised as either safe or unsafe for use.

Results:

78% of UVCs inserted were deemed safe for use on retrospective assessment. Where assessable, 8% (n=3) of safely positioned UVCs were unnecessarily removed. Worryingly, 24% (n=4) of malpositioned UVCs were not adjusted. In two cases, these UVCs were subsequently found to lie within the liver parenchyma, resulting in TPN peritonitis in one instance.

Conclusion: Our study highlights difficulties faced by paediatric trainees in the interpretation of UVC position on X-rays. Available guidelines focus upon a narrow range for the acceptable height of a line, with no commentary on the expected trajectory. This led to safe but not ‘perfectly’ positioned lines being removed as well as unsafe lines being left in position. We have therefore collated our X-ray images to create an interactive educational toolkit for trainees. We hope increased exposure to images will improve trainees’ confidence in neonatal anatomy and X-ray interpretation, reducing adverse patient events.