Objective: Thrombosis is a common complication of umbilical artery catheterization. The purpose of this study was to compare the novel ultralow umbilical artery catheter position (catheter tip at the junction of the umbilical and internal iliac arteries) versus the conventional high umbilical artery catheter position (tip in the aorta, above the diaphragm) for the incidence of thrombosis. Study design: This study was conduct- ed in a nonacademic, tertiary-referral neonatal center. The insertion and placement of the umbilical artery catheter was performed under continuous ultrasound guidance. Serial ultrasound examinations were per- formed to identify thrombosis in 38 consecutive newborns with an umbilical artery catheter placed in the novel ultralow position. The control group consisted of 50 infants with an umbilical artery catheter placed in the standard position. Results: The incidence of thrombosis requiring anticoagulant treatment was 22% in neonates with an umbilical artery catheter in the standard position. No thrombosis was detected in those with an umbilical artery catheter placed in the ultralow position. The study and control groups had similar catheter indwelling times (mean, 8.2 ± 4.1 vs. 8.5 ± 4.0 days, p = 0.687). Conclusions: This is the first report to present a novel position for the placement of umbilical artery catheters. The preliminary findings for the novel ultralow umbilical artery catheter position indicate that it may provide a safety benefit over the conventional umbilical artery catheter position.

Background: Umbilical venous catheter (UVC) placement is common in neonates but carries risks of migration and infection. This study evaluates safety of a novel fixation technique using the umbilical cord clamp after a side-entry insertion. Methods: A retrospective analysis of 264 neonates was conducted at a tertiary center in order to assess safety of the novel UVC fixation method. The new technique involved side-entry catheter insertion without severing the cord, secured to the clamp with a sterile patch. Catheter tip position was confirmed and monitored every 24 h via ultrasound. Results: Catheter migration occurred in 18.9% of cases, mostly inward into the right atrium which was managed by repositioning. Migration into the ductus venosus requiring removal occurred in 0.7% of cases and unscheduled removal due to stump detachment in 1.5%. No central line-associated bloodstream infections (CLABSIs) were observed. Conclusions: The umbilical cord clamp method is a safe, single-operator alternative for UVC fixation. This technique had a low rate of catheter migration, did not increase the risk of infection, and was cost-effective and simple.