Varying clinical presentations of umbilical venous catheter extravasation: A case series

Abstract

Umbilical venous catheter insertion is a common procedure in the neonatal units performed for rapid vascular access. Though relatively safe and easy to perform, suboptimal position of the catheter tip is frequently encountered and can lead to wide range of complications from venous thrombosis, catheter extravasation with extravasation of infusate to intraperitoneal or intrapericardial space, liver injury and cardiac arrhythmias. Identification of catheter extravasation may be difficult and often confused with catheter related infection or necrotising enterocolitis. We present a series of three cases of intraperitoneal extravasation of umbilical venous catheter in the premature neonate with widely varying presentation from subtle biochemical changes to critical clinical signs with rapid and progressive deterioration.

Point‐of‐care ultrasound aided diagnosis and management of peritoneal parenteral nutrition extravasation in a preterm baby: A case report

“…Having the background skills and knowledge to perform and interpret bedside POCUS may be additionally beneficial in leading clinicians to suspect UVC extravasation as a potential etiology. On review of previously documented US findings of UVC extravasation, a case series including three patients with described appearance of collapsed bowel loops, free fluid/ascites, and echogenic separate debris suggestive of hemorrhage fluid and an echogenic focus in the left lobe of the liver 5 . Additional literature describes the presence of intrahepatic collections in case reports reviewing UVC extravasation, which was not identified in our case 6–8 …”

Acute Management of Intraperitoneal Extravasation of Total Parenteral Nutrition (TPN) in a Very Preterm Infant: Case Report and Literature Review

“…The clinical spectrum of extravasation injury varies widely from insidious ascites, unexplained change in biochemical parameters to rapid intravascular volume depletion, and potentially catastrophic renal failure. 3 Paracentesis with catheter removal and aggressive supportive therapy may be lifesaving and potentially avoid the need for laparotomy. Resolution of the liver injury was noted over a period of several months.…”

“…2 Although it is a relatively easy-to-perform procedure, prior experience with UVC placement shows that ideal catheter tip position (upper border of T8 to lower border of T9 vertebral body) is not achieved in approximately 31.9% of cases. 3 Unfortunately, these central vein catheterisations are also associated with a number of complications. These include blood-borne catheter-related infection, blood loss during catheterisation or catheter detachment, air embolism, catheter tip migration, thromboembolic complications, cardiac tamponade, disorders of cardiac rhythm and pericardial or pleural effusion.…”

“…In a prospective study of 65 extremely low-birthweight infants, only 38% of catheter tips were in optimal position when its position was re-confirmed by POCUS, with catheter migration reported in up to 50% during the first week of life. 3,11 Active surveillance of catheter tip position, by either radiograph or preferably POCUS when expertise exists, is vital to prevent (or aid in early identification of) UVC extravasations. 3 This was highlighted in a recent study where a 4-day-old, 24-week gestational neonate developed isolated ascites.…”

“…3,11 Active surveillance of catheter tip position, by either radiograph or preferably POCUS when expertise exists, is vital to prevent (or aid in early identification of) UVC extravasations. 3 This was highlighted in a recent study where a 4-day-old, 24-week gestational neonate developed isolated ascites. POCUS revealed a malpositioned UVC, the removal of which resulted in prompt resolution of symptoms and hence prevention of any complications.…”