Broken Umbilical Artery Catheter: A Report of Two Cases

Abstract

Numerous complications of umbilical vessel catheterization have been reported.1-6 We have encountered two examples of broken catheters.Report of Cases.\p=m-\Case1.\p=m-\A 1,310-gm premature (32 weeks) female infant was born by spontaneous vaginal delivery. Shortly after birth, a No. 3.5 French polyvinyl catheter was introduced into an umbilical artery, with its tip located at the level of the third lumbar vertebra, for the management of the respiratory distress. The technique of insertion of the catheter was followed as Kitterman and others described.2,3 The catheter was stabilized with a purse-string suture using 4-0 silk and a noncutting needle. The umbilical stump was left open to air. Several hours later, because of continued oozing of blood, a second purse-string suture was applied to the umbilical stump. At 36 hours of age, the catheter was removed and was noted to be about 6 cm shorter than expected. Roentgenograms of the abdomen showed a residual length of catheter extending from the umbilicus to the lower abdominal aorta.Attempts at removal of the catheter by local dissection at the umbilicus failed, and the catheter was removed surgically by dissection of the right common iliac artery.The infant was discharged with a weight of 2,350 gm at 30 days of age, well and thriving.Case 2.-A 950-gm premature (28 weeks) female infant experienced severe respira¬ tory distress soon after birth. A polyvinyl umbilical artery catheter (No. 3.5 French) was inserted, and mechanical ventilation was instituted. On the fourth day of life, the catheter was removed, and a new Roentgenogram of tip of new catheter at level of third thoracic vertebra.arterial catheter was inserted. Roentgeno¬ grams showed the tip of the new catheter at the level of the third thoracic vertebra, but in addition, a separate piece of the first catheter measuring approximately 5 cm in length was noted in the thoracic aorta ( Figure). Thoracotomy was contemplated but deferred because of the infant's severe respiratory status. Subsequently pneumothoraces (eighth day), pneumonia, and Escherichia coli sepsis (ninth day) devel¬ oped as a result of prolonged ventilator therapy and central cut down (sixth day) for the nutrition. The infant died on the 33rd day of life. Repeated roentgeno¬ grams showed that the broken piece of the catheter had remained in its original posi¬ tion.Comment.-Umbilical catheters can be damaged by the needle, by scissors, or by pressure from a tightly tied suture. It is not possible to single out the mechanism of the breakage in either of our cases, but the purpose of this report is to emphasize this compli¬ cation to all personnel involved with daily management.

Infraumbilical surgical retrieval of transected umbilical artery catheter in an 840 g newborn

“…Although the study suggests an effective and safe retrieval of foreign body via catheterisation, this was in a mean age group of 4 years and 15 kg, with lowest age and weight being 7 days and 1.7 kg 7. Two more studies described a endovascular approach via umbilical artery in babies ≥1000 g 6–13…”

Percutaneous retrieval of embolized umbilical arterial catheter in extreme premature infant

“…Various mechanisms have been postulated for catheter rupture including damage to the catheter by needles, scissors, or pressure from a tightly tied suture to transection by sharp scissors or blades during insertion or removal. 6 –7 In addition, catheter type may affect risk of rupture. Catheters can be made from polyurethane or silastic (silicone).…”

“…Recommendations to decrease risk of catheter rupture are use of polyurethane catheters, avoidance of overly tight sutures for securement, avoidance of use of clamps on catheters during placement, avoidance of use of high pressures during hand flush procedures, and consideration of alternative means of catheter securement. 6,16 Of note, cyanoacrylate adhesives (CSCAs) have been shown to be safe and effective for securement of umbilical catheters 11 and their use may prevent damage to catheters from overly tightened sutures or manipulation secondary to catheter migration.…”

Successful retrieval of deep intracardiac migrated broken umbilical venous catheter in a preterm infant: Case report

“…The implementation of guidelines governing the use of umbilical catheters in the care of NICU patients holds the potential to standardize the application of this intervention, thus reducing the risk of unfavorable outcomes [8] . Additionally, it is crucial to adopt appropriate precautions, as inadvertent catheter damage can occur due to sharp tools (such as needles or blades) or tightened suturing during catheter insertion, fixation, or removal, particularly given the challenge of restraining neonates [9] . A best practice entails a meticulous assessment of catheters’ length for potential transections after their removal, employing imaging to eliminate the possibility of retained fragments as clinical presentation can be asymptomatic or misleading in certain cases [ 2 , 7 , 10 , 11 ].…”