NEONATAL VASCULAR CATHETERS AND THEIR COMPLICATIONS

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The infant in the neonatal intensive care unit (NICU) receives multiple invasive procedures including the placement of vascular catheters. Although traditional sites of access continue to be used, peripherally inserted central venous catheters (PICC lines), and catheters for extracorporeal membrane oxygenation are increasingly placed. The indications for these lines and the list of infusates are expanding. Radiologists are now placing many of these catheters. The method of placement, site of access, and use of the catheter are important because they directly contribute to the complications encountered.

Section snippets

VENOUS CATHETERS

Venous access is critical in the sick neonate. Patients in the NICU require parenteral antibiotics for treatment of sepsis or other infections, total parenteral nutrition (TPN) until they can take adequate nutrition enterally, and life support drugs. In addition, neonates have large fluid loses because of their relative large body surface area and require reliable access for hydration. Standard techniques, such as peripheral intravenous (PIV) lines and central venous catheters, commonly are

ARTERIAL CATHETERS

Arterial catheters are less frequently placed in the neonate compared with venous catheters. Their primary role is for invasive blood pressure monitoring and for laboratory sampling, such as arterial blood gas analysis. Both umbilical and peripheral approaches are available, with the umbilical site used more frequently.

EXTRACORPOREAL MEMBRANE OXYGENATION CATHETERS

Extracorporeal membrane oxygenation (ECMO) is performed on neonates with acute, severe, reversible, respiratory failure with no response to optimum ventilatory or pharmacologic treatment.99 Although patients initially had an expected mortality of 80%, the current survival rate is 81%.3, 67, 99, 101 Reasons for ECMO are meconium aspiration syndrome, primary pulmonary hypertension, congenital diaphragmatic hernia, hyaline membrane disease, and sepsis.99 Bypass is performed either with catheters

SUMMARY

There has been an evolution in vascular access in the neonate. Newer types of materials and catheters, such as PICC lines and ECMO catheters, are now available. The frequency of line placement has increased, and radiologists now perform many of these procedures. This places the radiologist in the position of not only diagnosing complications, but actually causing them. Knowledge of these complications can help the practitioner avoid them and diagnose them as quickly as possible when they occur.

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    Address reprint requests to Mark J. Hogan, MD, Department of Radiology, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205

    *

    Section of Vascular and Interventional Radiology, Department of Radiology, Columbus Children's Hospital, Columbus, Ohio

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