Category: Vascular access

Venous thrombosis in neonates

Venous thromboembolism is being increasingly diagnosed in neonates and is the result of a disturbance of the delicate balance between procoagulant and anticoagulant factors in neonatal blood. The primary risk factors are the use of central venous catheters, and prematurity.…

Inserting umbilical catheters: birth weight vs body measurement

A randomized trial from one center compared the percentage of umbilical catheters that were accurately placed when the catheter was placed using a birth-weight based formula¬†for calculating the insertion depth versus using a graph based on shoulder-umbilicus length. There was…

Heparin flushes prolonged peripheral IV catheter patency

A randomized trial compared the use of flushes with 1 ml of heparinized saline (10 U of heparin per ml) versus 1 ml of normal saline in maintaining the patency of peripheral intravenous catheters in neonates > 32 weeks gestation…

Infusion of TPN into the liver from malpositioned umbilical venous catheters

A case series from a single center describes five neonates who had parenteral nutrition inadvertently infused into the liver from malpositioned umbilical venous catheters. Presenting features were abdominal distension, hemodynamic instability and anemia. Diagnosis was confirmed by ultrasound which showed…

The value of bedside ultrasound

Point-of-care (bedside) ultrasound is increasingly being recommended as a valuable diagnostic and assessment tool in pediatric practice. Its use is growing rapidly in pediatric emergency medicine, critical care, and neonatology. It can aid in the performance of invasive procedures, focus…

Central venous catheter-related thrombi detected by routine ultrasound

An observational study assessed the frequency of thrombi related to central venous catheters. Any central venous catheter in place for longer than 14 days was studied with ultrasound surveillance twice a week. Around 1300 catheters were studied, and 10% of…

Locating UVC tip position with echocardiography

Thirty consecutive neonates in whom an umbilical venous catheter was placed concurrently underwent chest radiography, echocardiography by a pediatric cardiologist, and echocardiography by pediatric housestaff. The position of the tip of the UVC was determined by these three modalities. Around…

Revised UVC insertion formula

An observational (pre-post) study compared insertion of umbilical venous catheters using the Shukla formula ((3 x birthweight in kg + 9)/2)+1 cms to insertion using a formula where the 1 was not added, i.e., ((3 x birthweight in kg)+9)/2). The…

Extravasation injuries: prevention and treatment

A survey of 26 NICUs in Australia and New Zealand describes the practices in place in those units to prevent and treat intravenous catheter-related extravasation injuries. Methods to prevent peripheral IV extravasations included¬†frequent observation of the site, ensuring visibility of…