Umbilical venous catheterisation: emergency central venous access which saves lives in coarctation of the aorta

Abstract

We describe a 9-day-old baby with coarctation of the aorta who required urgent resuscitation including intubation and cardiac compressions. Despite the commencement of prostaglandin E1 (PGE1) to reopen the ductus arteriosus via the intraosseous route, postductal saturations remained unrecordable for a further 45 min. Within 3 min of administration of PGE1 via an umbilical venous catheter (UVC), saturations were recordable at 92%. UVC access was the sentinel intervention that irrevocably altered the clinical prognosis. This baby boy has survived with excellent neurodevelopmental outcome. Clinicians are less familiar with UVCs outside of the newborn period. Our data demonstrate successful placement in neonates up to 28 days of age. We hope this case encourages clinicians to consider the UVC as first-line central venous access in collapsed neonates. In cases of suspected left heart obstruction, we argue that UVCs are the optimal route.

Use of Intraosseous Access in Neonatal and Pediatric Retrieval—Neonatal and Pediatric Emergency Transfer Service, New South Wales

“…There is a single reported case study that cautions against the use of PGE 1 via a distal limb IO in a baby with left-heart obstruction. 15 No other studies assess the efficacy of PGE 1 via the IO route. Pharmacodynamics of IO drug delivery remains elusive and difficult to study in a randomized trial.…”

“…One baby continued to have PGE 1 administered via distal IO without clinical response. There is a single reported case study that cautions against the use of PGE 1 via a distal limb IO in a baby with left-heart obstruction 15 . No other studies assess the efficacy of PGE 1 via the IO route.…”

“…Another case study cautions IO use for prostaglandin E 1 (PGE 1 ) in the collapsed newborn with left heart obstruction, due to poor lower limb perfusion with subsequent poor drug delivery. 15 Studies in older children are mostly in the ED setting and focus on IO insertion success rates and complications. 11 Limited studies analyze IO indication, use, outcome, and survival in neonatal and pediatric resuscitation and emergency transport.…”

“…There are 12 case reports and one case series regarding the utility of IO access during neonatal resuscitation, 7 concluding that IO access should be considered when other routes of vascular access have failed. Another case study cautions IO use for prostaglandin E 1 (PGE 1 ) in the collapsed newborn with left heart obstruction, due to poor lower limb perfusion with subsequent poor drug delivery 15 . Studies in older children are mostly in the ED setting and focus on IO insertion success rates and complications 11 .…”

Umbilical vein catheter insertion without umbilical remnant in neonatal emergencies - A pilot study

“…They can be utilized for the administration of uids, medication, vasopressors and parenteral nutrition 2,3 . It is widely used in critical emergencies such as neonatal resuscitation 4 , neonatal congenital heart diseases 5 , exchange transfusion 6 , blood sampling 7 , and very low and extremely low birth weight neonates 8 . After sterilizing, standard procedures are supposed to take a scalpel and make a transverse cut completely through the umbilical stump 1 to 2 cm from the skin to expose the nondried umbilical cord to aid in anatomical identi cation and cannulation of the umbilical vein 9 .…”