Thrombotic Complications of Umbilical Artery Catheters: A Clinical and Radiographic Study

Catheterization of the aorta via the umbilical artery provides a convenient route for monitoring arterial blood pressure, for obtaining blood specimens for measurement of blood gas tensions and chemistries, and for the infusion of fluids and pharmacologic preparations in sick newborn infants. Use of this technique may be accompanied by a number of complications of which thrombotic phenomena are the most common. Twenty-three of 98 (24%) newborn infants undergoing umbilical artery catheterization were found to have thrombotic complications determined by aortography. No correlation was present between the duration of time that the umbilical artery catheters were in place and the occurrence of thrombotic complications. From paired aortographic or aortographic and autopsy studies in 24 patients, it was concluded that if a thrombotic complication did not occur early, none was likely to occur subsequently. One patient was considered to have died as a direct result of a thrombotic complication. Aortography is a safe, simple, and reliable technique for the early detection of thrombotic complications of umbilical artery catheters. Umbilical artery catheterization is not without risk and careful selection of patients for this procedure is indicated.

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Immunologic Studies of Antithrombin III Heparin Cofactor in the Newborn

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646736 ◽

1978 ◽

Vol 39 (03) ◽

pp. 624-630 ◽

Cited By ~ 21

Author(s):

W E Hathaway ◽

L L Neumann ◽

C A Borden ◽

L J Jacobson

Keyword(s):

Gestational Age ◽

Antithrombin Iii ◽

Newborn Infants ◽

Term Infant ◽

Sick Newborn ◽

At Iii ◽

Thrombotic Complications ◽

Low Levels ◽

Collection Methods ◽

Made In

SummarySerial quantitative immunoelectrophoretic (IE) measurements of antithrombin III heparin cofactor (AT III) were made in groups of well and sick newborn infants classified by gestational age. Collection methods (venous vs. capillary) did not influence the results; serum IE measurements were comparable to AT III activity by a clotting method. AT III is gestational age-dependent, increasing from 28.7% of normal adult values at 28-32 weeks to 50.9% at 37-40 weeks, and shows a gradual increase to term infant levels (57.4%) by 3-4 weeks of age. Infants with the respiratory distress syndrome (RDS) show lower levels of AT III in the 33-36 week group, 22% vs. 44% and in the 37-40 week group, 33.6% vs. 50.9%, than prematures without RDS. Infants of 28-32 week gestational age had only slight differences, RDS = 24%, non-RDS = 28.7%. The lowest levels of AT III were seen in patients with RDS complicated by disseminated intravascular coagulation and those with necrotizing enterocolitis. Crossed IE on representative infants displayed a consistent pattern which was identical to adult controls except for appropriate decreases in the amplitude of the peaks. The thrombotic complications seen in the sick preterm infant may be related to the low levels of AT III.

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Pulse Oximetry: An Alternative Method for the Assessment of Oxygenation in Newborn Infants

PEDIATRICS ◽

10.1542/peds.79.4.524 ◽

1987 ◽

Vol 79 (4) ◽

pp. 524-528

Author(s):

Michael S. Jennis ◽

Joyce L. Peabody

Keyword(s):

Pulse Oximetry ◽

Pulse Oximeter ◽

Arterial Oxygen Saturation ◽

Newborn Infants ◽

Fetal Hemoglobin ◽

Arterial Oxygen ◽

Skin Injury ◽

Reliable Technique ◽

Arterial Blood

Continuous monitoring of oxygenation in sick newborns is vitally important. However, transcutaneous Po2 measurements have a number of limiations. Therefore, we report the use of the pulse oximeter for arterial oxygen saturation (Sao2) determination in 26 infants (birth weights 725 to 4,000 g, gestational ages 24 to 40 weeks, and postnatal ages one to 49 days). Fetal hemoglobin determinations were made on all infants and were repeated following transfusion. Sao2, readings from the pulse oximeter were compared with the Sao2 measured in vitro on simultaneously obtained arterial blood samples. The linear regression equation for 177 paired measurements was: y = 0.7x + 27.2; r = .9. However, the differences between measured Sao2 and the pulse oximeter Sao2 were significantly greater in samples with > 50% fetal hemoglobin when compared with samples with < 25% fetal hemoglobin (P < .001). The pulse oximeter was easy to use, recorded trends in oxygenation instantaneously, and was not associated with skin injury. We conclude that pulse oximetry is a reliable technique for the continuous, noninvasive monitoring of oxygenation in newborn infants.

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UMBILICAL VESSEL ANGIOCARDIOGRAPHY IN THE NEWBORN INFANT

PEDIATRICS ◽

10.1542/peds.31.6.946 ◽

1963 ◽

Vol 31 (6) ◽

pp. 946-951

Author(s):

Samuel O. Sapin ◽

Leonard M. Linde ◽

George C. Emmanouilides

Keyword(s):

Newborn Infant ◽

Umbilical Artery ◽

Umbilical Vein ◽

Newborn Infants ◽

Umbilical Vessel ◽

Accurate Interpretation ◽

Sick Newborn

Angiocardiography from an umbilical vessel approach was performed in 10 critically sick newborn infants. The umbilical vein route was successfully employed up to the eighth day of life, while the umbilical artery was safely used as late as age 5 days. This approach has advantages over other methods of catheterization and angiocardiography. Angiocardiographic quality was satisfactory for accurate interpretation.

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ADVANTAGES AND COMPLICATIONS OF UMBILICAL ARTERY CATHETERIZATION IN THE NEWBORN

PEDIATRICS ◽

10.1542/peds.42.5.769 ◽

1968 ◽

Vol 42 (5) ◽

pp. 769-777

Author(s):

William D. Cochran ◽

Heather T. Davis ◽

Clement A. Smith

Keyword(s):

Fluid Therapy ◽

Causes Of Death ◽

Umbilical Artery ◽

Fluid Administration ◽

Blood Sampling ◽

Indwelling Catheter ◽

Local Complications ◽

Arterial Blood ◽

Umbilical Artery Catheterization

During a period of 5 years, 8 months, umbilical artery catheterization was performed on 387 infants in a newborn nursery. The indwelling catheter, at first introduced only to secure arterial blood for diagnostic and investigative purposes, was subsequently employed for intravascular fluid therapy in the same infant, and ultimately (in 51 of the 387 infants) for such fluid therapy alone. Complications observed were either vasospasm and temporary blanching of an extremity (13 infants: 11 surviving without apparent sequelae, 2 dying but without local complications at autopsy) or thrombosis, arteritis, or other inflammation noted at postmortem (18 infants). Such complications were not causes of death at autopsy, but their finding suggests the need for limiting the procedure to infants in whom any other route of blood sampling or fluid administration is particularly difficult.

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Should we put catheters in the umbilical artery?

PEDIATRICS ◽

10.1542/peds.62.5.853 ◽

1978 ◽

Vol 62 (5) ◽

pp. 853-854

Author(s):

William H. Tooley ◽

David Z. Myerberg

Keyword(s):

Umbilical Artery ◽

Newborn Infants ◽

The Body ◽

Blood Samples ◽

The Past ◽

Vasoactive Substances ◽

Arterial Blood ◽

Convenient Means ◽

Catheter Complications ◽

Septic Osteoarthritis

A catheter inserted in the umbilical artery with its tip in the aorta provides a convenient means for obtaining arterial blood samples, measuring pressure, and infusing fluids and drugs. Although these catheters often seem necessary to guide the treatment of newborn infants who have cardiopulmonary disease, they are dangerous. They are associated with thrombi, emboli, and infection. Their presence provokes vascular constriction and invites the infusion of vasoactive substances. Some catheter complications can be catastrophic. Recent reports include cases of hypertension,1 paraplegia,2 and septic osteoarthritis.3 In the past two years we have seen gangrene of a foot, a leg, and the lower half of the body.

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Disseminated Intravascular Coagulopathy in Hyaline Membrane Disease: Massive Thrombosis Following Umbilical Artery Catheterization

PEDIATRICS ◽

10.1542/peds.45.2.287 ◽

1970 ◽

Vol 45 (2) ◽

pp. 287-289

Author(s):

Joseph N. H. Du ◽

J. N. Briggs ◽

Gerald Young

Keyword(s):

Umbilical Artery ◽

Hyaline Membrane Disease ◽

Disseminated Intravascular Coagulopathy ◽

The Past ◽

Coagulation Defect ◽

Sick Newborn ◽

Cytomegalic Inclusion Disease ◽

Hyaline Membrane ◽

Intravascular Coagulopathy ◽

Umbilical Artery Catheterization

Disseminated intravascular coagulation in the newborn infant has received increasing attention in recent months1,2. In the cases reported so far it occurs in the very sick newborn, including those with hyaline membrane disease and intra-uterine infections, such as rubella, cytomegalic inclusion disease, and herpes simplex. The majority of the cases reported have been associated with severe hyaline membrane disease although the cause of the coagulation defect is not yet clear. Failure to recognize the coagulation defect in the past is probably due to inadequate coagulation studies. The present management of hyaline membrane disease is based on the assumption that adequate ventilation is essential for the child's survival.

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Umbilical Venous Catheter vs Umbilical Artery Catheter

PEDIATRICS ◽

10.1542/peds.86.3.495 ◽

1990 ◽

Vol 86 (3) ◽

pp. 495-495

Author(s):

Joseph A. Kitterman

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Umbilical Artery ◽

Newborn Infants ◽

Venous Catheter ◽

Invasive Procedures ◽

Relative Ease ◽

Mixed Venous Saturation ◽

Sick Newborn ◽

The Right ◽

Mixed Venous

In their commentary,1 Drs Dudell, Cornish, and Bartlett note that the measurement of mixed venous saturation (SVo2) is routine for infants receiving extracorporeal membrane oxygenation; in such infants, SVo2 can be measured easily without further invasive procedures. The authors recommend that clinicians use SVo2 measurements "more routinely" in other sick newborn infants and state that the measurement can be made with "relative ease" by inserting an umbilical venous catheter into the right atrium. This recommendation raises some concerns:

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COVID-19 as the cause of thrombosis: recognising COVID-19 infection in apparently asymptomatic patients

BMJ Case Reports ◽

10.1136/bcr-2020-241027 ◽

2021 ◽

Vol 14 (1) ◽

pp. e241027

Author(s):

Kyle B Varner ◽

Emily J Cox

Keyword(s):

Emergency Department ◽

Direct Result ◽

Abdominal Ct ◽

Call To Action ◽

Asymptomatic Patients ◽

Pulmonary Manifestations ◽

Abdominal Ct Scan ◽

Thrombotic Complications ◽

Work Up ◽

Renal Thrombosis

COVID-19 has serious thrombotic complications in critically ill patients; however, thrombus is not a typical presenting symptom. This case report describes a patient with no respiratory symptoms who presented to the emergency department with abdominal pain. The pain was attributed to renal thrombosis, but the patient was found to have no risk factors for thrombotic disease and subsequent hypercoagulable work-up was unremarkable. Pulmonary manifestations of COVID-19 infection were detected incidentally on the abdominal CT scan and confirmed via PCR test. The patient was isolated and went on to develop mild respiratory failure secondary to COVID-19 infection. This case suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.

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A Retrospective Propensity Score-Matched Early Thromboembolic Event Analysis of Prothrombin Complex Concentrate vs Fresh Frozen Plasma for Warfarin Reversal Prior to Emergency Neurosurgical Procedures

Neurosurgery ◽

10.1093/neuros/nyx327 ◽

2017 ◽

Vol 82 (6) ◽

pp. 877-886 ◽

Cited By ~ 6

Author(s):

Prateek Agarwal ◽

Kalil G Abdullah ◽

Ashwin G Ramayya ◽

Nikhil R Nayak ◽

Timothy H Lucas

Keyword(s):

Propensity Score ◽

Intracranial Hemorrhage ◽

Fresh Frozen Plasma ◽

Neurosurgical Procedures ◽

Thrombotic Complication ◽

Propensity Score Matching Analysis ◽

Therapeutic Anticoagulation ◽

Fresh Frozen ◽

Thrombotic Complications ◽

Frozen Plasma

AbstractBACKGROUNDReversal of therapeutic anticoagulation prior to emergency neurosurgical procedures is required in the setting of intracranial hemorrhage. Multifactor prothrombin complex concentrate (PCC) promises rapid efficacy but may increase the probability of thrombotic complications compared to fresh frozen plasma (FFP).OBJECTIVETo compare the rate of thrombotic complications in patients treated with PCC or FFP to reverse therapeutic anticoagulation prior to emergency neurosurgical procedures in the setting of intracranial hemorrhage at a level I trauma center.METHODSSixty-three consecutive patients on warfarin therapy presenting with intracranial hemorrhage who received anticoagulation reversal prior to emergency neurosurgical procedures were retrospectively identified between 2007 and 2016. They were divided into 2 cohorts based on reversal agent, either PCC (n = 28) or FFP (n = 35). The thrombotic complications rates within 72 h of reversal were compared using the χ2 test. A multivariate propensity score matching analysis was used to limit the threat to interval validity from selection bias arising from differences in demographics, laboratory values, history, and clinical status.RESULTSThrombotic complications were uncommon in this neurosurgical population, occurring in 1.59% (1/63) of treated patients. There was no significant difference in the thrombotic complication rate between groups, 3.57% (1/28; PCC group) vs 0% (0/35; FFP group). Propensity score matching analysis validated this finding after controlling for any selection bias.CONCLUSIONIn this limited sample, thrombotic complication rates were similar between use of PCC and FFP for anticoagulation reversal in the management of intracranial hemorrhage prior to emergency neurosurgical procedures.

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Benzyl Alcohol: Toxic Agent in Neonatal Units

PEDIATRICS ◽

10.1542/peds.72.3.356 ◽

1983 ◽

Vol 72 (3) ◽

pp. 356-358 ◽

Cited By ~ 1

Author(s):

◽

Keyword(s):

Benzyl Alcohol ◽

Multiple Dose ◽

Antimicrobial Agents ◽

Very Low Birth Weight ◽

Newborn Infants ◽

Isotonic Saline ◽

The United States ◽

Low Birth Weight Infants ◽

Toxic Agent ◽

Arterial Blood

As advances have been made in the care of very low-birth-weight infants, some techniques or practices have caused unexpected complications. One such practice is umbilical vessel catheterization to monitor an infant's arterial blood pressure, infuse fluids and medications, and obtain blood specimens for laboratory examinations. The catheters frequently are flushed with sterile isotonic saline or a 5% solution of dextrose in water, with the flush solution frequently being obtained from a multiple-dose vial. The United States Pharmacopeia requires all medications or solutions marketed in a multiple-dose vial to contain an antimicrobial preservative. Benzyl alcohol, an aromatic alcohol, is used for this purpose in a wide variety of medications and fluids for parenteral therapy, usually in a concentration of 0.9%. Two groups of investigators, Gershanik et al1 (New Orleans) and Brown et al2 (Portland), independently concluded that an intravascular infusion of flush solutions containing 0.9% benzyl alcohol caused severe metabolic acidosis, encephalopathy, respiratory depression with gasping, and perhaps other abnormalities leading to the death of a total of 16 infants. Blood and urine from several affected infants had high levels of both benzoic and hippuric acids, known metabolites of benzyl alcohol. Both groups stated that no additional cases occurred after solutions with benzyl alcohol preservative were banned in their nurseries. Subsequently, in May 1982, the Food and Drug Administration3 with the concurrence of the American Academy of Pediatrics and the Centers for Disease Control,4 urged pediatricians and other personnel in hospitals not to use fluids preserved with benzyl alcohol (or other antimicrobial agents) as intravascular flush solutions for newborn infants and not to use diluents with this preservative to reconstitute or dilute medications for infants.

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