19 Double Lumen (DL) Versus Single Lumen (SL) Umbilical Venous Catheters (UVCS) for Newborn Infants: A Systematic Review

Reliable vascular access can be problematic in sick neonates. In newborn babies, peripheral intravenous lines (PIVs), umbilical venous catheters, and percutaneously inserted central venous catheters are most often used to establish venous access. This systematic review will collate and analyze data on effectiveness and safety from randomized controlled trials, comparing DL-UVCs with SL-UVCs. Although it seems self-evident that DL-UVCs would reduce the need of additional venous lines, the rates of associated complications may be different. To compare the effectiveness and the safety of DL-UVCs versus SL-UVCs on: need of additional vascular access, rates of complications, morbidity and mortality. Randomized and quasi-randomized trials were identified by searching the Cochrane Controlled Trials Register, MEDLINE (1966 – November 2003), EMBASE (1980 – November 2003), CINAHL (1982 – November 2003), reference lists of published trials and abstracts published in Pediatric Research (1990–2003) from the SPR-PAS annual meetings. Randomized or quasi-randomized clinical trials comparing DL-UVCs vs. SL-UVCs in neonates (preterm and term). All data were analyzed using RevMan 4.2. Three trials qualified for inclusion in this review (Khilnani 1991, Loisel 1993, Soupre 1998). Need of additional peripheral intravenous lines in first week of life was reported in all three trials; there was a decrease in the usage of additional PIVs in DL-UVCs group in first week of life [WMD −1.38, 95% CI −1.80, −0.97], p<0.00001, number of infants (n)=99. All other outcomes {need of additional PIVs in first four weeks of life, failure rate of insertion of UVCs, failure to insert the UVC tip position in desired position, catheter life span, catheter malfunction (leak around catheter, catheter obstruction), complications (incidence of clinical sepsis, incidence of catheter related blood stream infection, catheter associated thrombosis, necrotizing enterocolitis), and all cause early neonatal mortality} were similar and statistically insignificant. This review demonstrated that use of DL-UVCs in neonates is associated with decrease in the usage of PIVs in first week of life in comparison to SL-UVCs. The implications of these findings are that, with the usage of DL-UVCs there is (a) potential to reduce the pain and stress associated with maintaining the intravenous access by decreasing the number of repeated venipunctures, and additional venous lines, and (b) cost savings by decreasing the usage of consumables (PIV catheters, arm-boards) and nursing time spent in inserting the PIVs.

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