Abstract:
Objective: The objective of this review is to systematically review the association between umbilical venous catheter (UVC) tip position and the risk of catheter-related complications in neonates.
Introduction: UVCs are commonly used in neonatal intensive care, with catheter tips typically positioned either in a recommended high (central) location at the inferior vena cava-right atrial junction or in a low-lying position below the diaphragm within the hepatic or portal venous circulation. Low-lying UVCs are frequently encountered in clinical practice, particularly when an optimal central placement cannot be achieved. Observational studies have raised concerns that low-lying tip positions, compared to centrally positioned UVCs, may be associated with increased risks of hepatic injury, thrombosis, catheter malfunction, and infection; however, findings are inconsistent. This systematic review will report the association between UVC tip position and the risk of catheter-related complications in neonates.
Eligibility criteria: Studies involving neonates with UVCs that compare low-lying tip positions to centrally placed UVCs and that report at least one clinical complication outcome will be eligible for inclusion. Cohort and case-control designs will be included.
Methods: A comprehensive search of MEDLINE, Embase, CINAHL, and Cochrane Library will be undertaken with no language restrictions, with additional searches of gray literature and trial registries. Two reviewers will independently screen the studies, assess methodological quality, and extract the data. Findings will be synthesized using meta-analysis when possible; otherwise, narrative synthesis will be used. Where appropriate, effect estimates will be pooled using random-effects models. The certainty of evidence will be assessed using GRADE.
Review registration: PROSPERO CRD420251250998.
Reference:McCord H, Bruce C, Norris N, Rothfus M, Goldchtaub L, Seamone A, Perrin J, Campbell-Yeo M. Complications and risks associated with low-lying umbilical venous catheters in neonates: a systematic review protocol. JBI Evid Synth. 2026 Jul 28. doi: 10.11124/JBIES-26-00033. Epub ahead of print. PMID: 42515955.