Keywords:
Paediatric, Liver, Vascular, Ultrasound, Ultrasound-Colour Doppler, Ultrasound-Power Doppler, Venous access, Localisation, Catheters, Embolism / Thrombosis, Trauma, Obstruction / Occlusion
Authors:
J. P. RAMIREZ1, M. X. escovar2; 1Caracas, Distrito Capital/VE, 2Caracas/VE
DOI:
10.26044/ecr2019/C-0231
Aims and objectives
Umbilical vein catheterization was performed in response to the need to administer medication to neonates. (1). These catheters have been widely used in neonatal intensive care rooms since 1947 (2). Umbilical venous catheterization often leads to complications. (3). Many of these complications may be associated with incorrect positioning of the catheter. (4). Correct positioning of catheters can be done by conventional radiography or ultrasound (5). Current evidence supports the use of ultrasound to locate the tip of the catheter. (6). There is a greater risk of mechanical complications associated with improper positioning of the tip of the catheter.
These complications include hepatic hematomas and portal thrombosis which in turn would increase the frequency of portal cavernomatosis and portal hypertension (7). The correct positioning of the tip of the catheter is important to prevent the portal venous system from receiving inappropriate hypertonic fluid that can produce hepatic necrosis. (8). Some authors report that the most common complication is portal pneumatosis,
followed by thrombosis of the left branch of the portal and thirdly hepatic hematomas. (9). The duration of the catheter must be minimized to reduce complications. (10). Portal cavernomatosis is the cause of 66% of cases of portal hypertension. (11). Radiological monitoring should be performed to assess the positioning of the distal end of the catheter.
(12). Some studies propose ultrasound as the method of choice for the initial assessment of the positioning of the umbilical vein catheter. (13). Portal pneumatosis,
apart from being a frequent complication of umbilical vein catheterization,
can be caused by necrotisingenterocolitis,
which is why the presence of this pathology should be ruled out in order to corroborate the suspicion that this complication has occurred as a result of catheterization. (14,
15). It is important to note that heparin treatment early after the diagnosis of portal thrombosis achieves recanalization of this venous line in 70% of cases. (16). Hepatic hematomas can be visualized as anechoic,
hypoechoic or echogenic images of defined borders at the hepatic parenchyma. (17).
Portal cavernomatosis is a rare disease,
caused by thrombosis of the portal vein,
and that can lead to portal hypertension.
(18). Portal hypertension causes certain complications that are life threatening. (19). Because of the association with complications,
it is very important that the umbilical vein catheterization is performed by highly trained personnel,
complying with all the necessary parameters for its correct placement.
After fulfilling these aspects,
the rate of incorrect positioning of the catheter must be reduced,
as well as the rate of complications. (20).
Considering all these aspects,
the following objectives are proposed:
Overall Aim
1.
Determine the portal system-related complications secondary to umbilical vein catheterization in neonates admitted to the neonatal intensive care unit (NICU) of the "Dr.
Miguel Pérez Carreño" Hospital (MPCH),
from May to September 2018.
Specific Aims
1.
Identify the frequency of portal system complications in patients who underwent umbilical vein catheterization.
2.
Establish the gestational age at which complications occur most frequently.
3.
Correlate the presence of portal complications with the positioning of the distal end of the catheter.
4.
Determine the gender in which complications occur most frequently.