Three cases of severe complications following umbilical venous catheter placement

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#IVTEAM #Intravenous literature: “Umbilical vein catheterization is widely used in neonatal units for critically ill neonates. It allows rapid central venous access for resuscitation, parenteral nutrition, medication, but may be associated with a risk of potentially life-threatening complications.” Cucerea et al (2014).

Reference:

Cucerea, M., Simon, M., Rusneac, M., Movileanu, C., Cioata, M., Zahiu, L. and Suciu, L. (2014) Life-threatening complications of the umbilical vein catheterization. Chest. 145(3 Suppl), p.450A.

Abstract:

SESSION TITLE: Pediatric Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM – 02:15 PM

PURPOSE: Umbilical vein catheterization is widely used in neonatal units for critically ill neonates. It allows rapid central venous access for resuscitation, parenteral nutrition, medication, but may be associated with a risk of potentially life-threatening complications. Proper position of the umbilical venous catheter (UVC) is at the junction of inferior vena cava and right atrium.

METHODS: we present three cases of severe complications following UVC placement

RESULTS: 1. A 36 weeks of gestational age newborn was transferred in our unit at 48 hours of life for sudden cardiac decompensation and signs of neonatal shock. At admisson he presented arrhythmic heart rate with weak heart sounds, unpalpable perypheral pulses, hypotension, tachypnea, mottled skin, severe vasomotor dysfunction. Chest X-ray showed gigant cardiomegaly and the tip of UVC in the left atrium. Massive pericardial effusion was found on echocardiography. Therapeutic interventions were: UVC retraction, pericardiocentesis under echocardiographic guidance, with tremendously improvement of the clinical status. 2. A term male newborn was transffered at 24 hours of life for severe hypoglicemia, neonatal sepsis and convulsions, reasons for UVC insertion, wich was removed after 14 days. At 21 days after birth he presented cardiac failure, persistent sepsis, and a new cardiac murmur. Echocardiography revealed hyperechoic oval shaped mass in size of 2.6/4.5mm in the right atrium (thrombus). Enoxaparine in a dose of 150 IU/kg was started for 6 weeks. He was discharged at 7 week of age, with no clinical and echografic signs of intracardiac thrombosis. 3. A term male newborn with birth weight of 3850 gm, was treated for congenital pneumonia for 10 days via UVC placed in a proper position. In the 10th day of life rutine abdominal ultrasound reveals a thrombus in size of 2,3/9,7 mm in the left branch of portal vein. Enoxaparina was started with good outcome.

CONCLUSIONS: once complications of UVC are diagnosed, patients should be treated immediately, but complications might be preventable by reevaluating indications for umbilical venous catheterization

CLINICAL IMPLICATIONS: umbilical vein catheterizations are at risk for vascular complications and need to be monitored

DISCLOSURE: The following authors have nothing to disclose: Manuela Cucerea, Marta Simon, Monika Rusneac, Carmen Movileanu, Madalina Cioata, Luminita Zahiu, Laura Suciu No Product/Research Disclosure Information.

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