Echocardiographic Determination of Umbilical Catheter Tip Location Mitigates Complications: A Randomized, Controlled Trial

<b>Background/Objectives</b>: Umbilical venous catheters (UVCs) and umbilical artery catheters (UACs) are essential for neonatal care, facilitating medication delivery, nutritional support, and blood pressure monitoring. However, malposition and prolonged catheter dwell time can lead to severe complications, including central line-associated bloodstream infections (CLABSIs). This study aims to evaluate the benefits of ultrasound in confirming catheter tip location, which may impact infection risk, and to assess the effectiveness of modification of the securing method. <b>Methods</b>: This prospective randomized controlled study was conducted from May 2022 to December 2024 at an NICU in Taiwan. Neonates requiring umbilical catheters were randomly assigned to three groups. In Group 1, the catheter length was calculated using a formula, X-ray confirmation was used, and the catheter was secured with traditional tape. In Group 2, ultrasound confirmation was used and the catheter was secured with FoamLite™ sterile dressing and transparent film. In Group 3, ultrasound confirmation was used and the catheter was secured with traditional tape. The outcomes were the rate of complications of the catheters. <b>Results</b>: Groups 2 and 3 demonstrated significantly lower malposition rates, microbial colonization, and CLABSI incidence compared to Group 1 (<i>p</i> = 0.001, 0.006, and 0.026, respectively). No significant difference was observed between Groups 2 and 3, suggesting that accurate tip positioning was more influential in reducing CLABSIs than the securing method itself. <b>Conclusions</b>: Ultrasound guidance improves catheter placement accuracy, minimizes malposition, lowers CLABSI risk, and reduces radiation exposure, supporting its broader implementation in NICUs.