Low Positioning of Umbilical-Artery Catheters Increases Associated Complications in Newborn Infants

Mokrohisky, Stefan T.; Levine, Rodney L.; Blumhagen, Joel D.; Wesenberg, Richard L.; Simmons, Michael

doi:10.1097/00006254-197906000-00014

Cited by 16 publications

(25 citation statements)

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“…Postulated mechanisms include the release of thrombi by the UAC, and decreased blood flow to the SMA secondary to a reduction in the diameter of the lumen of the aorta. [18][19][20] However, the effect of UACs on SMA blood flow remains controversial; several investigators report that UACs have no effect on SMA blood flow, 21,22 whereas others report that UACs are associated with reduced SMA blood flow. 16,17 Neonatology practice guidelines reflect the controversy regarding UAC effects on intestinal hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings

et al. 2007

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Objective: To investigate the effects of umbilical artery catheters (UACs) on superior mesenteric artery (SMA) blood flow velocity (BFV) following enteral feedings in very low birth weight preterm infants.Study design: Very low birth weight preterm infants who had UACs inserted as part of standard clinical care were enrolled in this prospective study. On the day the UAC was scheduled to be removed, pre-and postprandial SMA BFV (mean, peak systolic and end diastolic velocities) were measured in conjunction with a minimal enteral feeding given while the UAC was in place. The same measurements were made with the next feeding given after the UAC was removed. Preprandial measurements were made at least 3 h after the last enteral feeding, and postprandial measurements were made 30, 45 and 60 min after the feeding began. The same volume and type of feeding were used for both studies.Results: The birth weight and gestational age of the 19 infants who completed the study were 1014±221 g and 27.4±1.9 weeks, respectively. Infants were 4.6±1.7-days-old when the first SMA BFV measurement was made, the volume of enteral feedings was 1.3±0.6 ml, and the time between the two enteral feedings was 4.7±3.2 h. Preprandial SMA BFV did not differ with the UAC in place compared with the UAC removed. Peak postprandial velocities were at 45 min after feedings began. The percent increase from baseline was not significantly different with the UAC in place compared with the UAC removed. Keywords: very low birth weight; premature infant; blood flow velocity; superior mesenteric artery; nutrition; regional blood flow IntroductionThe superior mesenteric artery (SMA) is the blood vessel that supplies the greatest volume of blood to the small intestine. The use of Doppler ultrasound to measure SMA blood flow velocity (BFV) is increasingly used to investigate intestinal hemodynamics in neonates. We 1 and others 2-6 have demonstrated that SMA BFV progressively increases during the first week of life in preterm infants, which likely reflects increasing maturation of the intestinal tract. Several clinical factors may impact SMA BFV in preterm neonates, including the initiation of enteral feedings, 6-9 the administration of vasoactive medications, 10-13 the administration of continuous positive airway pressure, 1 phototherapy 14,15 and umbilical artery catherization. 16,17 Umbilical artery catheterization is a procedure commonly performed in very low birth weight (VLBW) infants. Umbilical artery catheters (UACs) are used for routine monitoring of blood gases and chemistries, and for the administration of fluid and hyperalimentation if alternative access is not available. Intestinal disturbances such as abdominal distension, ischemia and necrotizing enterocolitis have been attributed to UACs. Postulated mechanisms include the release of thrombi by the UAC, and decreased blood flow to the SMA secondary to a reduction in the diameter of the lumen of the aorta. [18][19][20] However, the effect of UACs on SMA blood flow remains controversial; several inv...

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Section: Introductionmentioning

confidence: 99%

Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings

et al. 2007

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“…This allows for continuous blood pressure monitoring, convenient arterial blood gas measurements, and painless blood sampling, with only little disturbance to the infant. However, UACs have been associated with complications such as local vascular (blanching or cyanosis of feet or toes) [2][3][4] or more extensive ischemic compromise, 4,5 aortic thrombi, 2,5-7 necrotizing enterocolitis, 5 arterial hypertension, 2 hematuria, 5 and hyperglycemia. 8 -13 As high-placed UACs have been shown to be safer with regard to clinical vascular complications, many institutions prefer the high-positioned (thoracal 6 -9) UAC.…”

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confidence: 99%

Slow Blood Sampling From an Umbilical Artery Catheter Prevents a Decrease in Cerebral Oxygenation in the Preterm Newborn

et al. 2003

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ABSTRACT.Objective. Blood sampling from an umbilical artery catheter (UAC) placed in a high position (thoracal 6 -9) has the potential to produce clinically significant changes in cerebral blood flow and, thereby, in cerebral oxygenation. This may contribute to cerebral impairment in preterm newborn infants. Therefore, we set up a study to determine the effects of different sampling speeds through a UAC on cerebral oxygenation in preterm infants.Methods. Thirty pairs of measurements were conducted on 20 preterm infants (median gestational age: 30.14 weeks; median birth weight: 1170 g). For each infant, 2 blood samplings (both 2.3 mL, including flush volume) through the UAC in high position were taken at 2 different speeds (20 and 40 seconds) in alternating sequence. Cerebral oxygenation was measured noninvasively by near-infrared spectroscopy. Concentration changes in cerebral oxygenated hemoglobin (O 2 Hb) and deoxygenated hemoglobin (HHb), along with the tissue oxygenation index (TOI; O 2 Hb/[O 2 Hb ؉ HHb] ؋ 100), were recorded while blood was withdrawn and subsequently reinfused.Results. A significant decrease in O 2 Hb and TOI occurred during blood sampling within 20 seconds (median ⌬O 2 Hb: ؊1.5 mol/L; range: ؊4.1-2.3; median ⌬TOI: ؊0.6%; range: ؊6.3-2.3), whereas HHb increased (median ⌬HHb: 0.4 mol/L, range: ؊1. 1-3.9) N eonatal mortality has markedly decreased in the past decades because of better prenatal fetal care and, postnatally, because of the ever-expanding diagnostic and therapeutic means available to neonatologists. The limit of viability, which was approximately 28 weeks' gestation 10 years ago, has been constantly lowered to below 26 weeks, with a current 52% survival rate for liveborn infants who are born at 25 weeks. 1 Unfortunately, the decrease in mortality has not been accompanied by a decrease in mid-and long-term morbidity affecting especially the neurodevelopmental outcome. If prenatal damage to the central nervous system can frequently not be prevented, then everything needs to be done to decrease further all possible risks of postnatal cerebral lesions in infants who undergo intensive care, the most vulnerable among these being preterm infants.The vast majority of very preterm and severely ill newborn infants are monitored using an umbilical artery catheter (UAC). This allows for continuous blood pressure monitoring, convenient arterial blood gas measurements, and painless blood sampling, with only little disturbance to the infant. However, UACs have been associated with complications such as local vascular (blanching or cyanosis of feet or toes) 2-4 or more extensive ischemic compromise, 4,5 aortic thrombi, 2,5-7 necrotizing enterocolitis, 5 arterial hypertension, 2 hematuria, 5 and hyperglycemia. 8 -13 As high-placed UACs have been shown to be safer with regard to clinical vascular complications, many institutions prefer the high-positioned (thoracal 6 -9) UAC. A recent Cochrane Review concluded that there seems to be no evidence to support the use of low-placed UACs, and, therefo...

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“…The level of catheter placement in the aorta is controversial. Seibert et al and others recommend positioning the catheter just above the aortic bifurcation [10][11][12], although the formation of thrombi in this position is more likely [13]. The complications of catheters placed higher in the aorta although less frequent involve the visceral vasculature and are more life-threatening [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, attention should be directed to signs of systemic manifestation of on-going thrombosis and thrombolysis, metabolic acidosis, hypertension, etc [12]. There may be poor correlation between clinical findings, and the development of thrombosis as a precursor of major complication [10,13]. Therefore, the most effective way of prevention is close monitoring of all infants at high risk.…”

Section: Discussionmentioning

confidence: 99%

Gluteal Necrosis with Ano-Gluteal Fistula: A Result of Umbilical Artery Catheterization

Al-Arfaj

Khwaja

1991

Ann Saudi Med

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Low Positioning of Umbilical-Artery Catheters Increases Associated Complications in Newborn Infants

Cited by 16 publications

References 0 publications

Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings

Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings

Slow Blood Sampling From an Umbilical Artery Catheter Prevents a Decrease in Cerebral Oxygenation in the Preterm Newborn

Gluteal Necrosis with Ano-Gluteal Fistula: A Result of Umbilical Artery Catheterization

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