Livaoglu Say B., Serçe Pehlevan Ö., Tugral O.
Medical Science and Discovery, vol.13, no.2, pp.15-20, 2026 (Peer-Reviewed Journal)
Abstract
Objective: Accurate positioning of the umbilical venous catheter (UVC) tip is critical for reducing catheter-related complications in preterm infants. This study aimed to compare the accuracy of the Revised Shukla–Ferrara formula and the Dunn nomogram for UVC insertion depth estimation using echocardiography as the reference standard, and to evaluate the concordance between anteroposterior (AP) chest radiography and echocardiography in confirming UVC tip position.
Material and Methods: This retrospective case–control study included 69 preterm infants who underwent UVC placement in two level III neonatal intensive care units. Insertion depth was determined using either the Revised Shukla–Ferrara formula (n = 43) or the Dunn method (n = 26). UVC tip position was initially assessed by AP chest radiography and subsequently verified by echocardiography. Placement accuracy and concordance between imaging modalities were analyzed.
Results: On chest radiography, accurate placement rates were 53.5% in the Revised Shukla–Ferrara group and 42.3% in the Dunn group. The Revised Shukla–Ferrara formula was more frequently associated with low placement, whereas the Dunn method showed a higher rate of high placement. Echocardiography demonstrated correct UVC positioning in 61.8% of infants in the Revised Shukla–Ferrara group and 38.2% in the Dunn group. Notably, substantial discordance was observed between radiography and echocardiography, with a significant proportion of malpositioned catheters misclassified as accurately positioned on chest X-ray.
Conclusion: Both the Revised Shukla–Ferrara formula and the Dunn method are useful for estimating UVC insertion depth in preterm infants; however, each demonstrates distinct malposition tendencies. Reliance on AP chest radiography alone is insufficient for confirming accurate UVC tip placement. Routine echocardiographic verification should be incorporated into standard NICU practice to enhance procedural safety and reduce catheter-related complications.