Complications Following Umbilical Vein Catheterization in Preterm Neonates – Single-Center

Document Type : Original Article


1 Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina, Novi Sad, Serbia

2 Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina, Novi Sad, Serbia 2. Faculty of Medicine, University of Novi Sad, Serbia



Background: Despite their widespread use, umbilical venous catheters (UVCs) are associated with various complications.
Methods: This single-center retrospective cohort study examined UVC-related complications in preterm neonates within a tertiary Neonatal Intensive Care Unit (NICU) from January 2020 to December 2022. The study aimed to analyze these complications in relation to UVC positioning.
Results: Over the course of three years, 146 preterm neonates underwent UVC insertion. The cohort's mean gestational age was 29.2 ± 3 weeks, with a median birth weight of 1110 g (817-1482 g). The median UVC placement duration was 8 days (6-10), totalling 1220 catheter days. Overall, 37% of the UVC placements were categorized as optimal, 35.6% as low-lying, 20.5% as high-lying, and 6.8% were categorized as malpositioned. The UVC-related complications occurred in 62 neonates (42.5%), with central line-associated bloodstream infection (CLABSI) in 8.2%, portal vein thrombosis (PVT) in 2.7%, pericardial effusion in 0.7%, and necrotizing enterocolitis (NEC) in 2.7% of neonates. The incidence of UVC-related complications was lowest with high-lying positions (23.3%), followed by optimal positioning (31.5%), low-lying (63.5%), and the highest in malpositioned UVCs (70%). UVC placement exceeding 8 days were significantly associated with increased complications.
Conclusion: The study highlights an elevated rate of complications associated with umbilical vein catheterization emphasizing the need for judicious use, especially in preterm neonates.


  1. MacDonald MG. Atlas of procedures in neonatology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2002;173–181.
  2. Gordon A, Greenhalgh M, McGuire W. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Cochrane Database Syst Rev. 2017;10(10):CD012142.
  3. Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens VEHJ, Steggerda SJ, et al. Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study. Front Pediatr. 2017;5:142. 
  4. 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):337-343.
  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):1802-1815.
  6. Verheij G, Smits-Wintjens V, Rozendaal L, Blom N, Walther F, Lopriore E. Cardiac arrhythmias associated with umbilical venous catheterization in neonates. BMJ Case Rep. 2009;2009:bcr04. 2009.1778.
  7. Sheta A, Al-Awad E, Soraisham A. Supraventricular tachycardia associated with umbilical venous catheterization in neonates. J Clin Neonatol. 2018;7(3):166–169.
  8. Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol. 2007;27(5):317-319.
  9. Abdellatif M, Ahmed A, Alsenaidi K. Cardiac tamponade due to umbilical venous catheter in the newborn. BMJ Case Rep. 2012;2012:bcr-2012-6160.
  10. Grizelj R, Vukovic J, Bojanic K, Loncarevic D, Stern-Padovan R, Filipovic-Grcic B, et al. Severe liver injury while using umbilical venous catheter: case series and literature review. Am J Perinatol. 2014;31(11):965-974.
  11. Derinkuyu BE, Boyunaga OL, Damar C, Unal S, Ergenekon E, Alimli AG, et al. Hepatic complications of umbilical venous catheters in the neonatal period: The ultrasound spectrum. J Ultrasound Med. 2018;37(6):1335-1344.
  12. Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. Catheter tip position and risk of mechanical complications in a neonatal unit. An Pediatr (Barc). 2016;85(2):77-85.
  13. Mutlu M, Aslan Y, Kul S, Yılmaz G. Umbilical venous catheter complications in newborns: A 6-year single-center experience. J Matern Fetal Neonatal Med. 2016;29(17):2817-2822.
  14. Shahroor M, Maarouf AM, Yang J, Yankanah R, Shah PS, Mohamed A. Complications associated with low position versus good position umbilical venous catheters in neonates of ≤32 weeks' gestation. Am J Perinatol. 2022;39(3):259-264.
  15. El Ters N, Claassen C, Lancaster T, Barnette A, Eldridge W, Yazigi F, et al. Central versus low-lying umbilical venous catheters: A multicenter study of practices and complications. Am J Perinatol. 2019;36(11):1198-1204.
  16. Joghee S, Kamaluddeen M, Soraisham A. low-lying umbilical venous catheters are not always associated with increased complications. Newborn 2022;1(1):1–6.
  17. Heijting IE, Antonius TAJ, Tostmann A, de Boode WP, Hogeveen M, Hopman J; Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. Sustainable neonatal CLABSI surveillance: consensus towards new criteria in the Netherlands. Antimicrob Resist Infect Control. 2021;10(1):31.
  18. Juhl SM, Hansen ML, Gormsen M, Skov T, Greisen G. Staging of necrotizing enterocolitis by Bell's criteria is supported by a statistical pattern analysis of clinical and radiological variables. Acta Paediatr. 2019;108(5):842-848.
  19. British Association of Perinatal Medicine. Use of central venous catheters in neonates: a framework for practice. [Accessed January 11, 2021]. Available at: bapm/attachment/file/17/BAPM_CVC_final_Jan16__addition_Aug_2018_.pdf
  20. Chinnaswamy K, Chandramohan A, Kadirvel K, Palanisamy S. Incidence of complications following umbilical vein catheterization in neonates. Int J Contemp Pediatr 2019;6:1863-1866.
  21. Bannatyne M, Smith J, Panda M, Abdel-Latif ME, Chaudhari T. Retrospective cohort analysis of central line associated blood stream infection following introduction of a central line bundle in a neonatal intensive care unit. Int J Pediatr. 2018;2018:4658181.
  22. Fisher D, Cochran KM, Provost LP, Patterson J, Bristol T, Metzguer K, et al. Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics. 2013;132(6):e1664-1671.
  23. Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr. 2013;102(7):e293-298.
  24. Blanchard AC, Fortin E, Rocher I, Moore DL, Frenette C, Tremblay C, et al. Central line-associated bloodstream infection in neonatal intensive care units. Infect Control Hosp Epidemiol. 2013;34(11):1167-1173.
  25. Shalabi M, Adel M, Yoon E, Aziz K, Lee S, Shah PS; Canadian Neonatal Network. Risk of infection using peripherally inserted central and umbilical catheters in preterm neonates. Pediatrics. 2015;136(6):1073-1079.
  26. Jansen SJ, van der Hoeven A, van den Akker T, Veenhof M, von Asmuth EGJ, Veldkamp KE, et al. A longitudinal analysis of nosocomial bloodstream infections among preterm neonates. Eur J Clin Microbiol Infect Dis. 2022;41(11):1327-1336.
  27. D'Andrea V, Prontera G, Rubortone SA, Pezza L, Pinna G, Barone G, Pittiruti M, Vento G. Umbilical venous catheter update: A narrative review including ultrasound and training. Front Pediatr. 2022;9:774705.
  28. Hollingsworth C, Clarke P, Sharma A, Upton M. National survey of umbilical venous catheterisation practices in the wake of two deaths. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F371-372.
  29. Butler-O'Hara M, D'Angio CT, Hoey H, Stevens TP. An evidence-based catheter bundle alters central venous catheter strategy in newborn infants. J Pediatr. 2012;160(6):972-7.e2.
  30. Leveillee A, Lapointe A, Lachance C, Descarries M, Autmizguine J, Dubois J, et al. Assessing the effect of catheter type and position on central line-associated bloodstream infections in the NICU. Paediatr Child Health. 2018;23(Suppl 1):e59.
  31. Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion therapy standards of practice, 8th J Infus Nurs. 2021;44(1S Suppl 1):S1-S224.
  32. Marshall AS, Jayapal SS, Whitburn JA, Akinbiyi BA, Willetts IE. Recognizing serious umbilical cord anomalies. BMJ Case Rep. 2013;2013:bcr 2013201663.
  33. Goh SSM, Kan SY, Bharadwaj S, Poon WB. A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore. Singapore Med J. 2021;62(1):29-33.
  34. Chen HJ, Chao HC, Chiang MC, Chu SM. Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience. Pediatr Neonatol. 2020;61(1):16-24.
  35. 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):F251-F255.
  36. Karber BC, Nielsen JC, Balsam D, Messina C, Davidson D. 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.
  37. kar 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):369-372.
  38. Mutlu M, Parıltan BK, Aslan Y, Eyüpoğlu İ, Kader Ş, Aktürk FA. Comparison of methods and formulas used in umbilical venous catheter placement. Turk Pediatri Ars. 2017;52(1):35-42.
  39. Dubbink-Verheij GH, Visser R, Tan RNGB, Roest AAW, Lopriore E, Te Pas AB. Inadvertent migration of umbilical venous catheters often leads to malposition. Neonatology. 2019;115(3):205-210.
  40. Hoellering A, Tshamala D, Davies MW. Study of movement of umbilical venous catheters over time. J Paediatr Child Health. 2018;54(12):1329-1335.
  41. 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.
  42. 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):679-688.