Diagnostic accuracy of X-ray imaging for the tip position of umbilical venous catheter: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHENG Xu ¹ , ZHANG Yuan ¹ , DU Juan ¹ , LUO Jingjie ¹ , LIU Yali ² ,  HEI Mingyan ¹

1. Neonatal Center, National Center for Child Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, P. R. China;
2. Department of Clinical Epidemiology, National Center for Child Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, P. R. China;

Corresponding author：

HEI Mingyan, Email: heimingyan@bch.com.cn

Keywords：

Umbilical veins; Central venous catheters; X-ray; Newborn; Meta-analysis; Diagnostic tests

DOI：

10.7507/1672-2531.202303054

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Objective To evaluate the diagnostic accuracy and efficacy of X-ray for evaluating the tip position of umbilical venous catheterization (UVC). Methods The PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests for UVC tip localisation from inception to 1 May 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality of the studies using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 16.0 software. Results Twelve articles involving 1 055 patients were included. The sensitivity and specificity of Negar Yazdani’s study were both 100%. The results of the meta-analysis (the remaining eleven articles, n=951) indicated a pooled sensitivity of 0.7 (95%CI 0.6 to 0.8), a pooled specificity of 0.8 (95%CI 0.7 to 0.9), a positive likelihood ratio of 4.0 (95%CI 2.0 to 8.1), a negative likelihood ratio of 0.4 (95%CI 0.2 to 0.6) and a diagnostic odds ratio of 11 (95%CI 3 to 36) with an area under the cumulative receiver operating characteristic curve of 0.8 (95%CI 0.8 to 0.9). A subgroup analysis was performed according to the different methods of judging X, the 8^th–9^th thoracic, the 9^th–10^th thoracic and combined judgement of the diaphragmatic plane + the vertebral body + the heart shadow. The sensitivities of the 3 groups were 0.8 (95%CI 0.5 to 0.9), 0.5 (95%CI 0.4 to 0.7) and 0.8 (95%CI 0.6 to 0.9); the specificities of the 3 groups were 0.8 (95%CI 0.6 to 0.9), 0.76 (95%CI 0.6 to 0.9) and 0.91 (95%CI 0.79 to 0.96). The areas under the cumulative receiver operating characteristic curve were 0.9 (95%CI 0.8 to 0.9), 0.7 (95%CI 0.6 to 0.7) and 0.92 (95%CI 0.89 to 0.94). Conclusion Some error is present when determining the catheter tip position by X-ray, in which the evaluation of the umbilical vein catheter tip position through a comprehensive evaluation of the diaphragmatic plane, the heart margin and the vertebral body is more powerful than the evaluation of the vertebral body alone.

Citation： ZHENG Xu, ZHANG Yuan, DU Juan, LUO Jingjie, LIU Yali, HEI Mingyan. Diagnostic accuracy of X-ray imaging for the tip position of umbilical venous catheter: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(12): 1387-1392. doi: 10.7507/1672-2531.202303054 Copy

1.	Pourarian S , Badfar G , Yazdani N . Evaluation of umbilical vein catheter position in neonates by thoraco-abdominal radiography versus echocardiography. Iran J Pediatr, 2020.
2.	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): 567-572.
3.	Kishigami M, Shimokaze T, Enomoto M, et al. Ultrasound-guided umbilical venous catheter insertion with alignment of the umbilical vein and ductus venosus. J Ultrasound Med, 2020, 39(2): 379-383.
4.	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice, 8th Edition. J Infus Nurs, 2021, 44(Suppl 1): 1-224.
5.	Gibson K, Sharp R, Ullman A, et al. Adverse events associated with umbilical catheters: a systematic review and meta-analysis. J Perinatol. 2021, 41(10): 2505-2512.
6.	Elbatreek M, Shehata NB, Abu-Shaheen A, et al. Neonatal pericardial effusion and tamponade after umbilical venous catheter insertion and the use of saline contrast echo as a diagnostic tool. Am J Case Rep. 2019, 20: 1382-1386.
7.	Cao J, Zhang Y, Yin Y, et al. Accuracy of chest radiography compared to ultrasound for positioning the umbilical venous catheter in neonates: a meta-analysis and systematic review. J Vasc Access, 2021.
8.	Shabeer MP, Abiramalatha T, Gibikote S, et al. Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates - a prospective diagnostic evaluation study. J Neonatal Perinatal Med, 2021, 14(1): 101-107.
9.	Akar S, Dincer E, Topcuoğlu S, et al. Determination of accurate position of umbilical venous catheters in premature infants. Am J Perinatol, 2022, 39(4): 369-372.
10.	Dubbink-Verheij GH, Visser R, Tan RNGB, et al. Inadvertent migration of umbilical venous catheters often leads to malposition. Neonatology, 2019, 115(3): 205-210.
11.	林创廷, 黄翔, 王巧洪, 等. 超声定位与标准X线在新生儿脐静脉置管后异位评估的效果对比. 广东医学, 2018, 39(14): 2196-2199.
12.	Guimarães AF, Souza AA, Bouzada MC, et al. Accuracy of chest radiography for positioning of the umbilical venous catheter. J Pediatr (Rio J), 2017, 93(2): 172-178.
13.	Franta J, Harabor A, Soraisham AS. Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study. Arch Dis Child Fetal Neonatal Ed, 2017, 102(3): 251-255.
14.	El-Maadawy SM, El-Ataw KM, Elhalik MS. Role of bedside ultrasound in determining the position of umbilical venous catheters. J Clin Neonat, 2015, 4(3): 173.
15.	Hoellering AB, Koorts PJ, Cartwright DW, et al. Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med, 2014, 15(1): 56-61.
16.	Harabor A, Soraisham A. Rates of intracardiac umbilical venous catheter placement in neonates. J Ultrasound Med, 2014, 33(9): 1557-1561.
17.	Michel F, Brevaut-Malaty V, Pasquali R, et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation, 2012, 83(6): 705-709.
18.	Greenberg M, Movahed H, Peterson B, et al. Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr, 1995, 126(4): 633-635.
19.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
20.	Soonsawad S, Kieran EA, Ting JY, et al. Factors associated with umbilical venous catheter malposition in newborns: a tertiary center experience. Am J Perinatol. 2022, 39(16): 1805-1811.
21.	中华医学会儿科学分会新生儿学组, 中国妇幼保健协会医院感染控制专业委员会, 国家儿童医学中心, 等. 新生儿脐静脉置管相关并发症防控指南. 中华新生儿科杂志, 2021, 36(2): 1-9.
22.	Eifinger F, Fuchs Z, Koerber F, et al. Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns. Clin Anat, 2018, 31(2): 269-274.
23.	Simanovsky N, Ofek-Shlomai N, Rozovsky K, et al. Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol, 2011, 21(9): 1882-1886.
24.	Karber BC, Nielsen JC, Balsam D, et al. Optimal radiologic position of an umbilical venous catheter tip as determined by echocardiography in very low birth weight newborns. J Neonatal Perinatal Med, 2017, 10(1): 55-61.
25.	Yadav A, Meena J, Kumar 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): 1163.

1. Pourarian S , Badfar G , Yazdani N . Evaluation of umbilical vein catheter position in neonates by thoraco-abdominal radiography versus echocardiography. Iran J Pediatr, 2020.
2. 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): 567-572.
3. Kishigami M, Shimokaze T, Enomoto M, et al. Ultrasound-guided umbilical venous catheter insertion with alignment of the umbilical vein and ductus venosus. J Ultrasound Med, 2020, 39(2): 379-383.
4. Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice, 8th Edition. J Infus Nurs, 2021, 44(Suppl 1): 1-224.
5. Gibson K, Sharp R, Ullman A, et al. Adverse events associated with umbilical catheters: a systematic review and meta-analysis. J Perinatol. 2021, 41(10): 2505-2512.
6. Elbatreek M, Shehata NB, Abu-Shaheen A, et al. Neonatal pericardial effusion and tamponade after umbilical venous catheter insertion and the use of saline contrast echo as a diagnostic tool. Am J Case Rep. 2019, 20: 1382-1386.
7. Cao J, Zhang Y, Yin Y, et al. Accuracy of chest radiography compared to ultrasound for positioning the umbilical venous catheter in neonates: a meta-analysis and systematic review. J Vasc Access, 2021.
8. Shabeer MP, Abiramalatha T, Gibikote S, et al. Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates - a prospective diagnostic evaluation study. J Neonatal Perinatal Med, 2021, 14(1): 101-107.
9. Akar S, Dincer E, Topcuoğlu S, et al. Determination of accurate position of umbilical venous catheters in premature infants. Am J Perinatol, 2022, 39(4): 369-372.
10. Dubbink-Verheij GH, Visser R, Tan RNGB, et al. Inadvertent migration of umbilical venous catheters often leads to malposition. Neonatology, 2019, 115(3): 205-210.
11. 林创廷, 黄翔, 王巧洪, 等. 超声定位与标准X线在新生儿脐静脉置管后异位评估的效果对比. 广东医学, 2018, 39(14): 2196-2199.
12. Guimarães AF, Souza AA, Bouzada MC, et al. Accuracy of chest radiography for positioning of the umbilical venous catheter. J Pediatr (Rio J), 2017, 93(2): 172-178.
13. Franta J, Harabor A, Soraisham AS. Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study. Arch Dis Child Fetal Neonatal Ed, 2017, 102(3): 251-255.
14. El-Maadawy SM, El-Ataw KM, Elhalik MS. Role of bedside ultrasound in determining the position of umbilical venous catheters. J Clin Neonat, 2015, 4(3): 173.
15. Hoellering AB, Koorts PJ, Cartwright DW, et al. Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med, 2014, 15(1): 56-61.
16. Harabor A, Soraisham A. Rates of intracardiac umbilical venous catheter placement in neonates. J Ultrasound Med, 2014, 33(9): 1557-1561.
17. Michel F, Brevaut-Malaty V, Pasquali R, et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation, 2012, 83(6): 705-709.
18. Greenberg M, Movahed H, Peterson B, et al. Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr, 1995, 126(4): 633-635.
19. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
20. Soonsawad S, Kieran EA, Ting JY, et al. Factors associated with umbilical venous catheter malposition in newborns: a tertiary center experience. Am J Perinatol. 2022, 39(16): 1805-1811.
21. 中华医学会儿科学分会新生儿学组, 中国妇幼保健协会医院感染控制专业委员会, 国家儿童医学中心, 等. 新生儿脐静脉置管相关并发症防控指南. 中华新生儿科杂志, 2021, 36(2): 1-9.
22. Eifinger F, Fuchs Z, Koerber F, et al. Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns. Clin Anat, 2018, 31(2): 269-274.
23. Simanovsky N, Ofek-Shlomai N, Rozovsky K, et al. Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol, 2011, 21(9): 1882-1886.
24. Karber BC, Nielsen JC, Balsam D, et al. Optimal radiologic position of an umbilical venous catheter tip as determined by echocardiography in very low birth weight newborns. J Neonatal Perinatal Med, 2017, 10(1): 55-61.
25. Yadav A, Meena J, Kumar 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): 1163.

Chinese Journal of Evidence-Based Medicine

Diagnostic accuracy of X-ray imaging for the tip position of umbilical venous catheter: a meta-analysis

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