Rotura y desplazamiento de catéter arterial umbilical: obstrucción arterial bilateral en un prematuro de muy bajo peso al nacer

Abstract

Umbilical vessel catheterization is a common procedure in Neonatal Intensive Care Units, especially in very low birthweight infants. Rarely, umbilical artery catheters break, and the retained fragments can cause thrombosis, infection, distal embolization, and even death. Herein, we describe a neonate with clinically significant bilateral limb ischemia developing after removal of a broken umbilical artery catheter. He was under vasodilator treatment in addition to fibrinolytic and anticoagulants. The evolution was favourable.

Retained Catheter in the Aorta

“…This case demonstrates an incidental finding of a retained umbilical artery catheter fragment in an adult patient’s aorta. There are several case reports of retained umbilical artery catheter fragments in neonates and infants, which resulted in thrombosis, infection, and embolization 1,2. This is the first known finding of a retained umbilical artery catheter found in an adult patient.…”

Topical nitroglycerin in newborns with ischemic injuries: A systematic review

“…Neonates, especially those of extremely low gestational age, have an immature hemostatic system, vulnerable and narrow blood vessel diameter and overall are at higher-risk for adverse outcomes including ischæmic complications such as tissue necrosis and gangrene. ( Elboraee et al, 2018 , Dilli et al, 2015 , Beall et al, 2013 , Vasquez et al, 2003 ).…”

“…This may manifest clinically as blanched, mottled skin, peripheral cyanosis, weak pulses, and consequently, permanent tissue necrosis if urgent intervention is not instituted ( Sadat et al, 2015 , Arshad and McCarthy, 2009 ). The conventional management of peripheral ischemia caused by arterial lines consists of urgent catheter removal, elevation of the affected limb, and induction of reflex vasodilation by applying heat to the contralateral limb ( Dilli et al, 2015 , Arshad and McCarthy, 2009 ). In most cases, these combined strategies fall short of improvement and further measures need to be implemented.…”

“…In our review among reports where a direct cause and effect relationship was evident, peripheral arterial catheterization was identified as the source of regional tissue ischemia in 14 infants, followed by peripheral venous catheterization (n = 4) and umbilical arterial catheterization in 4 cases ( Table 4 ). ( Dilli et al, 2015 ) reported a rare incidence of a broken umbilical arterial catheter followed by bilateral lower ischemic extremities. There was one report of ischemic changes after insertion of a brachial artery catheter ( Zarkesh, 2020 ).…”

A novel use of ultrasound for the extraction of a fractured umbilical arterial catheter

“…Risks with these catheters include perforation during insertion, bacterial colonisation, increased incidence of thrombosis and embolism, and occasionally transection. [234] A fragmented retained umbilical catheter acts as a nidus for bacterial colonisation, thrombosis and can embolise and compromise distal vascular beds. This necessitates its retrieval, which can be done endovascularly or through open surgery.…”