Survey of Umbilical Artery Catheter Practices

Gilhooly, Joseph; Lindenberg, Jeffrey A.; Reynolds, John W.

doi:10.1097/00003246-199002000-00028

Cited by 6 publications

(4 citation statements)

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“…In one study, heparin was implicated as a risk fastor for ICH in low birth weight infants (47).However, this study wim retrospective and the 95% confidence interval around the odds ratio of 3.9 was large (L.4-1 1 .0), ffid the magnitude of the .risk uncertain (47). A survey of American nurseries in 1986 reported that 75% of nurseries used heparin prophylaxis in concentrations between 0.01 and 2.0 units per ml (48 (49,50). The long-term morbidity may manifest as hypertension, abnormal renal function, and/or discrepancies in leg measurements, with claudication.…”

Section: Clinical Presentation the Clinical Presentation Of Aorticmentioning

confidence: 78%

Arterial Thromboembolic Complications in Paediatric Patients

et al. 1997

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Recent successes in tertiary care paediatrics are paradoxically responsible for the majority of arterial thromboembolic events (TEs) which present significant management dilemmas because they cause considerable morbidity ffid, in some cases, rnortality. The most common etiology of arterial thromboembolic disease is an arterial catheter placed for invasive monitoring of children with serious primary problems. Non-catheter related arterial TEs are relatively rare and can be considered as those within the central nervous system (CNS) (ischemic stroke) and those outside of the CNS which include Takayasu's arteritis (1-3), thrombosis in arteries of transplanted organs (4-8), occlusion of coronary aneurysrs secondary to Kawasaki's disease (9-11), and as complications of some forrrs of congenital heart disease (CHD). Because of the relatively low incidence of arterial TEs in children, the diagnostic and therapeutic approaches are frequently extrapolated from adult guidelines. In doing so, clinicians assume that the epidemiology of arterial thrombotic disease is similar in children and adults which is unlikely. A Medline search of the literature since 1975 was performed (reference list available upon request). The following review summarrzes available information on the clinical presentation, diagnostic evaluation, therapeutic interventions and clinical outcome of arterial TEs during childhood. Comparisons to adult patients are made when relevant. Catheter Related Arterial Thromboembolic Complications Arterial catheterization is performed for diagnostic, therapeutic and monitoring purposes. They iue thrombogenic because of the foreign surface, damage to vessel walls, arterial spasm, disruption of blood flow and infusion of substances that may be thrombogenic. The paediatric population requiring arterial catheters can be considered in three groups: (a) cardiac catheterization (CC) which is usually performed through a femoral artery, (b) umbilical artery catheterization in newborns (UAC), and (c) peripheral arterial catheters (PACs) in the intensive care setting.

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Section: Clinical Presentation the Clinical Presentation Of Aorticmentioning

confidence: 78%

Arterial Thromboembolic Complications in Paediatric Patients

et al. 1997

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“…Continuous low-dose heparin has been used widely to maintain the patency of central and peripheral intravenous catheters on the assumption that the low concentration of heparin accomplishes this goal without causing hemorrhagic complications (Rajani, Goetman, Wenneberg, Turner, & Abilgaard, 1979). Controlled studies in adults show the efficacy of heparin in reducing thrombophlebitis in peripheral (Gillhooly, Lindenberg, & Reynolds, 1986;Tanner, Delaney, & Hennessy, 1980) and central vein infusion sites (Brismar, Hardstedt, &Jacobson, 1982;Daniell, 1973;Fabri, Mirtallo, & Ruberg, 1982;Hoar, Wilson, Mangano, & Avery, 1981) and in prolonging the time until infiltration (Gillhooly et al, 1986).…”

Section: Related Literaturementioning

confidence: 99%

“…Studies in newborns show the benefits of both intermittent and continuous heparin infusion in preventing clot formation, reducing the incidence of line-related complications (Horgan et al, 1970), and prolonging the patency of umbilical vessel catheters without increasing the incidence of clinical bleeding (Bosque &Weaver, 1987;David, Merten, Anderson, & Gross, 1981;Gillhooly et al, 1986;Kitterman, Phibbs, & Tooley, 1981;Rajani et al, 1979).…”

Section: Heparin In Peripheral Venous Infusionmentioning

confidence: 99%

Emacy of Heparin in Peripheral Venous Infusion in Neonates

Treas

Latinis-Bridges

1992

Journal of Obstetric, Gynecologic & Neonatal Nursing

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“…The reported rates of catheter-related thrombi range from 20 to 90%. The wide range reflects the various methods used for thrombus detection as well as the inconsistent use of prophylactic anticoagulants (4)(5)(6)(7)(8)(9)(10)(11). Although catheter-related thrombosis usu ally results in simple loss of catheter patency, it may also producing life-threatening complications.…”

Section: Introductionmentioning

confidence: 99%

Fibrin Clot Lysis by Thrombolytic Agents Is Impaired in Newborns due to a Low Plasminogen Concentration

et al. 1992

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SummaryAlthough thrombolytic drugs have been extensively used in adults, there is sparse information on their effectiveness in newborns whose fibrinolytic system differs significantly from adults. The purpose of this study was to determine if low plasma levels of plasminogen in cord plasma limited the therapeutic effectiveness of thrombolytic agents. Urokinase (UK), streptokinase (SK) and tissue plasminogen activator (TPA) were compared for their ability to lyse washed 125I-labelled adult or cord fibrin clots suspended in cord or adult plasma. 125I-labelled fibrin clots were prepared by recalcifying cord or adult plasma spiked with labelled fibrinogen and then placed into cord or adult plasma which contained either saline or differing amounts of a specific thrombolytic agent. After a 60 min incubation, the remaining 125I-fibrin in clots released 125I-fibrin fragments, and concentrations of fibrinogen, α2-antiplasmin, and plasminogen in the bathing plasma were measured and compared to starting values. Cord fibrin clots were more resistant than adult fibrin clots to all thrombolytic drugs tested (p <0.001). On average, the cord system retained 27% more 125I-fibrin in clots, and released 32% less 125I-fibrin fragments into plasma. Fibrinogenolysis was also decreased in cord plasmas compared to adult plasmas. The degree of fibrinolysis and fibrinogenolysis in cord plasma increased to adult values when plasminogen concentrations were increased in the bathing plasma. Thus, cord fibrin clots have an impaired response to thrombolytic agents secondary to low levels of plasminogen. We speculate that the clinical response of newborns to thrombolytic agents is also impaired and will not be enhanced by increasing doses of thrombolytic agents but may be enhanced by increasing the concentration of plasminogen.

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Survey of Umbilical Artery Catheter Practices

Cited by 6 publications

References 0 publications

Arterial Thromboembolic Complications in Paediatric Patients

Arterial Thromboembolic Complications in Paediatric Patients

Emacy of Heparin in Peripheral Venous Infusion in Neonates

Fibrin Clot Lysis by Thrombolytic Agents Is Impaired in Newborns due to a Low Plasminogen Concentration

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