Gangrene of the Lower Extremities of Infants after Femoral Venipuncture

Femoral arterial thrombosis in nephrotic syndrome.

“…Goldbloom, Hillman, and Santulli (1967) reported three nephrotic children receiving corticosteroids in whom femoral vein puncture was followed by thrombosis of the femoral artery and amputation, with death in one case. Femoral artery thrombosis has also been reported after femoral vein puncture in nonnephrotic infants (Nabseth and Jones, 1963). It is difficult to assess the amount of risk; thousands of femoral vein punctures are performed in children every year without incident (McKay, 1966), and probably some dozens of these are on nephrotic children.…”

Vascular compromise in newborn infants.

“…45 Intentional and inadvertent arterial puncture is also known to cause arterial thrombosis,46 especially if a substance which irritates the vessel initima is infused.47 Even a vasculitis in a newborn infant has presented with peri- 48 pheral gangrene. Intravascular catheters can act as a nidus for fibrin and platelets, may damage the endothelium of the vessel wall, may partially occlude a vessel, and may precipitate vasospasm.…”

Peripheral gangrene in hypernatraemic dehydration of infancy.

“…Sporadic case reports of peripheral gangrene associated with diarrhoea and dehydration in neonates and infants have appeared in recent years (Manios, Kanakoudi, and Miliaras-Vlachakis, 1972;Shehadi, Slim, and Dabbous, 1968;Smith et al, 1965;Nabseth and Jones, 1963;Bowie, McKenzie, and Hansen, 1958). Several causative factors for this complication have been suggested.…”

“…They include Esch. coli endotoxin triggering disseminated intravascular coagulation (DIC) (Manios et al, 1972), femoral venepuncture (Nabseth and Jones, 1963), other needle trauma, purpura fulminans, thrombotic thrombocytopenic purpura, or an increase in blood viscosity due to dehydration (Shehadi et al, 1968). When recorded, the serum sodium concentration in these infants has invariably been in the hypernatraemic range (> 160 mEq/l), though the association between gangrene and hypernatraemia does not appear to have been noted before.…”