Supra umbilical line placement: alife savior approach in sick neonates and early infants with cicatrized umbilical stump

Objective: The umbilical venous catheterization is one of the fastest approaches for venous access in neonates. We describe here a novel supra umbilical line placement (SULP) technique in neonates and early infants, in whom umbilical stump had cicatrized; as a fast and life saving approach.
Methods: A single-center retrospective study over 18 months reviewing complications related to UVC insertion by SULP technique in neonates. Ideal UVC position was defined as catheter tip within 0.5 cm above or below the diaphragm. Catheter-associated bloodstream infection (CABSI) was defined as the positive microbiological growth in one or more blood cultures obtained from a symptomatic infant up to two days after UVC placement or within 48 hours of catheter removal.
Results: Total 11 patients had UVC insertion by SULP technique. The mean age at SULP was 25.9 post-natal days. The mean birth weight was 2.5 kg. The primary indications for SULP were prolonged antibiotics in 4, total parenteral nutrition in 4, difficult intravenous access in 2 and recurrent hypoglycemia in 1 patient. Out of 11 SULP, 5 were ideal, 4 were deep and 2 were short in catheter tip position. Mean duration of indwelling catheter was 5.3 days. Complications of SULP included CABSI, peritoneum breach during procedure, catheter blockage, surgical site infection in 1 patient each. None of the neonates had UVCs complicated by malposition, extravasation, venous thrombosis.
Conclusion: SULP is an easy, effective and life saving bed side procedure in sick neonates and early infants with difficult intravenous and intra-umbilical line access.