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Armağan C, Çapıtlı T, Dilmen G, Kefeli SÇ, Ulusoy O, Erdoğan F, Duman N, Özkan H. Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge. Z Geburtshilfe Neonatol 2024. [PMID: 38710220 DOI: 10.1055/a-2295-5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Managing acute abdomen in very low birth weight (VLBW) and premature infants presents a diagnostic challenge, often necessitating a thorough assessment to discern underlying causes. Umbilical venous catheters (UVCs), commonly used in neonatal intensive care, are essential but not without risks. A 29-week premature male infant, born to a 23-year-old mother, was referred to our clinic on the 16th day of life with a suspected diagnosis of necrotizing enterocolitis (NEC). The infant had spent the first day intubated and received non-invasive respiratory support for 15 days. A 5 French UVC was inserted at the 2nd hour of life, and by the 3rd day of life, the infant transitioned to minimal enteral feeding. Between the 12th and 16th days of life, the infant initially diagnosed with NEC due to symptoms such as decreased stool passage and abdominal distension. The patient had been on a continuous course of antibiotic treatment throughout the entirety of his life, commencing on the very first day due to suspected early neonatal sepsis, followed by nosocomial sepsis during the hospitalization, and persisting with antibiotic therapy for suspected NEC. The case took a unique turn upon further evaluation after being referred to our unit. Despite a preliminary NEC diagnosis, further evaluation revealed umbilical catheter complications, leading to total parenteral nutrition extravasation. Removal of the catheter, drainage, and antibiotic adjustment resulted in improved clinical outcomes. In neonatal care, cautious management is vital when dealing with infants exhibiting abdominal symptoms. A nuanced approach, including differential diagnosis and careful antibiotic use, is essential.
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Affiliation(s)
- Coşkun Armağan
- Dokuz Eylul University Faculty of Medicine, Neonatology, Izmir, Turkey
| | - Tevfik Çapıtlı
- Dokuz Eylul University Faculty of Medicine, Pediatrics, Izmir, Turkey
| | - Gülsüm Dilmen
- Dokuz Eylul University Faculty of Medicine, Pediatrics, Izmir, Turkey
| | - Saadet Çağla Kefeli
- Dokuz Eylul University Faculty of Medicine, Pediatric Surgery, Izmir, Turkey
| | - Oktay Ulusoy
- Dokuz Eylul University Faculty of Medicine, Pediatric Surgery, Izmir, Turkey
| | - Funda Erdoğan
- Dokuz Eylul University Faculty of Medicine, Neonatology, Izmir, Turkey
| | - Nuray Duman
- Dokuz Eylul University Faculty of Medicine, Neonatology, Izmir, Turkey
| | - Hasan Özkan
- Dokuz Eylul University Faculty of Medicine, Neonatology, Izmir, Turkey
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Balasundaram P, Lucena MH, Jiang L, Nafday S. Unveiling Peripherally Inserted Central Catheter Fractures and Related Complications in the Neonatal Intensive Care Unit: A Concise Review. Cureus 2023; 15:e47572. [PMID: 38021894 PMCID: PMC10666564 DOI: 10.7759/cureus.47572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Peripherally inserted central catheters (PICCs) have become popular over tunneled catheters in neonatal intensive care units (NICUs) due to their ease of use and convenience. Although rare, a PICC fracture can be a severe and potentially fatal complication. This narrative review aims to identify factors predisposing neonates to PICC fracture and related complications, such as catheter jamming, and explore strategies for preventing and detecting this complication. A thorough search of PubMed and Google Scholar was conducted using relevant keywords to identify articles discussing PICC fracture in neonates. The review encompassed English-language literature on PICC fracture in neonates, with additional pertinent publications identified through citation searching. The incidence of PICC fracture in neonates varies from less than 1% to 10%, with a higher risk associated with prolonged catheterization, lower gestational age and lower birth weight, and the use of multi-lumen catheters. PICC fractures can occur during insertion, maintenance, or removal. Factors such as catheter duration, gestational age, birth weight, and catheter type increase the risk of PICC fracture. Excessive syringe pressure, securement failure, and excessive force during removal are contributing factors. Catheter fatigue and thin-walled catheter design are common causes of breakage. Preventive measures include proper training of healthcare providers, regular monitoring, early recognition, and prompt catheter removal upon fracture. Preventing and detecting PICC fractures is crucial for neonatal safety. Vigilance during insertion, maintenance, and removal, along with care to avoid excessive force during removal and high pressure during flushing, can help prevent catheter breakage. More research is required to improve prevention strategies for PICC fractures in neonates.
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Affiliation(s)
- Palanikumar Balasundaram
- Department of Pediatrics, Division of Neonatology, Javon Bea Hospital-Riverside, Mercy Health system, Rockford, USA
| | - Michelle H Lucena
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, USA
| | - Lan Jiang
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, USA
| | - Suhas Nafday
- Department of Pediatrics, Division of Neonatology, Jack D. Weiler Hospital, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, USA
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Baehner T, Rohner M, Heinze I, Schindler E, Wittmann M, Strassberger-Nerschbach N, Kim SC, Velten M. Point-of-Care Ultrasound-Guided Protocol to Confirm Central Venous Catheter Placement in Pediatric Patients Undergoing Cardiothoracic Surgery: A Prospective Feasibility Study. J Clin Med 2021; 10:jcm10245971. [PMID: 34945270 PMCID: PMC8706795 DOI: 10.3390/jcm10245971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Central venous catheters (CVC) are commonly required for pediatric congenital cardiac surgeries. The current standard for verification of CVC positioning following perioperative insertion is postsurgical radiography. However, incorrect positioning may induce serious complications, including pleural and pericardial effusion, arrhythmias, valvular damage, or incorrect drug release, and point of care diagnostic may prevent these serious consequences. Furthermore, pediatric patients with congenital heart disease receive various radiological procedures. Although relatively low, radiation exposure accumulates over the lifetime, potentially reaching high carcinogenic values in pediatric patients with chronic disease, and therefore needs to be limited. We hypothesized that correct CVC positioning in pediatric patients can be performed quickly and safely by point-of-care ultrasound diagnostic. Methods: We evaluated a point-of-care ultrasound protocol, consistent with the combination of parasternal craniocaudal, parasternal transversal, suprasternal notch, and subcostal probe positions, to verify tip positioning in any of the evaluated views at initial CVC placement in pediatric patients undergoing cardiothoracic surgery for congenital heart disease. Results: Using the combination of the four views, the CVC tip could be identified and positioned in 25 of 27 examinations (92.6%). Correct positioning was confirmed via chest X-ray after the surgery in all cases. Conclusions: In pediatric cardiac patients, point-of-care ultrasound diagnostic may be effective to confirm CVC positioning following initial placement and to reduce radiation exposure.
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Affiliation(s)
- Torsten Baehner
- St. Nikolaus-Stiftshospital Andernach, Ernestus-Platz 1, 56626 Andernach, Germany;
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Marc Rohner
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Nadine Strassberger-Nerschbach
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
- Correspondence: ; Tel.: +49-228-287-14116
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Hugill K, van Rens M. Inserting central lines via the peripheral circulation in neonates. ACTA ACUST UNITED AC 2021; 29:S12-S18. [PMID: 33104432 DOI: 10.12968/bjon.2020.29.19.s12] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripherally inserted central catheters (PICCs) are extensively used in neonatal intensive and high-dependency care settings. These intravenous catheters provide medium to longer-term access to the circulatory system for the delivery of medications, parenteral nutrition and the like. Catheters are available in a variety of bespoke designs and materials, each with their unique characteristics, benefits and limitations. PICCs are frequently inserted in a sterile zone cot-side procedure, one that requires an advanced knowledge base, technical skill and training. This article relates some important practical advice around managing minor complications that can be encountered while using the modified Seldinger technique (MST) to insert neonatal PICCs, which can make this procedure a less stressful experience for both infants and health professionals.
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Affiliation(s)
- Kevin Hugill
- formerly Director of Nursing (Education), Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Matheus van Rens
- Director of Nursing (Clinical) NICU, Women's Wellness and Research Center, Hamad Medical Corporation, Qatar
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Ultrasound-guided umbilical venous catheterisation: A cost-effectiveness analysis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó M, Ángel-Selfa M, Riera-Torres M. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.enfie.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[Ultrasound-guided umbilical venous catheterisation: A cost-effectiveness analysis]. An Pediatr (Barc) 2019; 92:215-221. [PMID: 31129027 DOI: 10.1016/j.anpedi.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/28/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p=.04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p<.0001). The cost-effectiveness ratio of the guided catheterisation was €153.9, and €484.6 for the conventional one. The incremental cost-effectiveness ratio was €45.5. The sensitivity analysis showed a €2.6 increase in the cost-effectiveness ratio of the guided catheterisation and €47 in the conventional one. CONCLUSIONS The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.
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Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó MJ, Ángel-Selfa MJ, Riera-Torres MJ. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. ENFERMERIA INTENSIVA 2018; 30:170-180. [PMID: 30563790 DOI: 10.1016/j.enfi.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/08/2018] [Accepted: 10/23/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peripherally inserted central catheters have become a priority in infants who require long-term intravenous therapy, but their use involves certain risks. OBJECTIVE The aim of the study was to describe the occurrence of adverse events in newborns with peripherally inserted central catheters and to determine the risk factors associated with them. METHODS A descriptive cross-sectional study was designed and performed. All neonates with peripherally inserted central catheters from October 1st, 2014 to September 30th, 2015 were included. The adverse events and sociodemographic and clinical variables related to neonates and analyzed catheters were recorded. RESULTS A total of 140 catheters were placed in 116 infants. All of them were analyzed. Adverse events occurred in 16.4%: catheter-associated bacteraemia (5.7%), obstruction (5.7%), extravasation (2.1%) and phlebitis (2.1%), <27weeks of pregnancy (OR=1.2, P=.02), birth weight <1000g (OR=6.7, P=.02), with catheters in situ for longer than one week (OR=9.8, P=.02) and with perfusion of antibiotics per catheter (OR=1.3, P<.01). Phlebitis is associated with the insertion of the catheter in LL and head (OR=1.1, P=.03). Factors associated with bacteraemia risk with adjusted prevalence odds ratio are extremely low birth weight neonates (OR=6.38; P=.03) and with a catheter in situ for longer than one week (OR=9.41; P=.04). CONCLUSIONS The periodic evaluation of catheter-related adverse events is very useful to prepare improvement plans. This will maximize safety for the most vulnerable newborns, especially those of extremely low birth weight that require very long treatments.
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Affiliation(s)
- C Padilla-Sánchez
- Enfermera Interna Residente en Enfermería Obstétrico-Ginecológica (Matrona), Hospital Universitario y Politécnico La Fe, Grupo de Investigación Perinatología IIS La Fe, Valencia, España
| | - R Montejano-Lozoya
- Escuela de Enfermería La Fe. Universidad de Valencia. IIS La Fe. Grupo de Investigación GREIACC, Valencia, España.
| | - L Benavent-Taengua
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Monedero-Valero
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M J Borras-Vañó
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M J Ángel-Selfa
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M J Riera-Torres
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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