Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. Double lumen umbilical venous catheters in critically ill neonates: a randomized prospective study.
Central venous lines are used to care for critically ill neonates in cases of limited peripheral venous access. This prospective, randomized study evaluated the risks and benefits of the use of single- and double-lumen umbilical venous catheters for up to 14 days. Patients were randomized to one of three treatment arms: (1) single-lumen umbilical catheter, (2) double-lumen umbilical catheter, or (3) no umbilical catheter; peripheral intravenous lines only. Infants in the groups treated with an umbilical venous catheter had significantly fewer venipunctures and peripheral intravenous lines placed during their first 2 weeks of life than those in the peripheral line only group. Less time and money were spent obtaining peripheral line placement in the umbilical venous catheter groups. The incidence rates of sepsis and complications were not higher in treated patients than in control patients. The double-lumen catheter further reduced peripheral venipunctures and lines. We conclude that an umbilical venous catheter used during the first 2 weeks of life is a relatively safe, less stressful, cost-effective means of providing intravenous therapy to neonates. To compare relative efficacies and complications associated with the use of double lumen vs. single lumen umbilical venous catheters in critically ill neonates.
                Prospective randomized control trial.
                Neonatal ICU.
                Forty-three critically ill neonates.
                Group 1 patients (n = 20) received single lumen umbilical venous catheters and group 2 patients (n = 23) received double lumen catheters. A record of the following information was kept: demographic data including diagnosis and indication for umbilical venous catheter insertion, catheter tip location, length of catheterization (days), number of additional iv catheters and complications (sepsis, hepatic necrosis, thrombosis, or mechanical complications).
                Double lumen umbilical venous catheters were well tolerated and were associated with no significant increased risk of mechanical complications when compared with single lumen umbilical venous catheters. The number of additional iv catheters required (0.8 +/- 0.1 [SD]) was significantly (p less than .05) less in the double lumen umbilical venous catheter group as compared with additional iv catheters required (2.3 +/- 0.8) in the single lumen umbilical venous catheter group.
                Double lumen umbilical venous catheters are well tolerated for short-term use, decrease the need for additional venous catheters in critically ill neonates, and may not significantly increase the risk of mechanical complications when compared with single lumen umbilical venous catheters.
The use of ML-UVCs in comparison to SL-UVCs in neonates is associated with decrease in the usage of PIVs in first week of life, but an increase in catheter malfunctions. As the quality of included randomized studies is poor and the estimates of clinically important complications are imprecise, no firm recommendations can be made regarding the choice of UVC. Adequately powered, properly randomized and properly blinded controlled trials are needed that address the effectiveness and safety of ML-UVCs (double and triple lumen) in comparison to SL-UVCs. These studies should also address the impact of type of catheter material.