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Images in neonatal medicine
Contrast study in umbilical venous line extravasation
  1. Susan Rutendo Kamupira,
  2. James Dexter Tarr,
  3. Minju Kuruvilla
  1. St Mary's Hospital, Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
  1. Correspondence to Dr Susan Rutendo Kamupira, St Mary's Hospital, Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester M13 9WL, Greater Manchester, UK; Susan.Kamupira{at}mft.nhs.uk

https://doi.org/10.1136/archdischild-2020-321081

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    A preterm infant born at 25 weeks’ gestation, birth weight 730 g, had an umbilical venous catheter (UVC) inserted on day 1. The line bled and flushed freely at 5 cm and would not sample beyond this position. Supine abdominal X-ray (AXR) showed vertical position of the line with the tip at T11–T12. This was recognised as a suboptimal position but attempts to secure intravenous access with a percutaneous long line was unsuccessful. The UVC remained in situ and was used to administer total parenteral nutrition. Baby gradually became unstable on day 3 with abdominal distension, metabolic acidosis, rising urea and hyperglycaemia. An AXR on day 4 showed low-lying UVC (L1 position) and featureless bowel gas pattern. UVC extravasation was suspected, and this was confirmed with contrast injection. The UVC was removed and an improvement in bloods, oxygen requirement and blood glucose was seen within 24 hours. Baby recovered without further complications.

    Extravasation is a known complication of umbilical venous catheter (UVC) placement.1 It has been reported to present in a manner mimicking necrotising enterocolitis and can lead to significant morbidity or mortality (figure 1).2 In this case, contrast administration combined with a degree of clinical suspicion demonstrated hepatic extravasation as the cause of the patient’s deterioration. There is evidence routine contrast use in checking tip positions improves long line positioning3 and British Association of Perinatal Medicine (BAPM) has included this in it's central access guidance.4 Here we demonstrate it can be used to check the position of umbilical central access and to demonstrate extravasation (figure 2).

    Figure 1
    Figure 1

    Low-lying umbilical venous catheter.

    Figure 2
    Figure 2

    Contrast study showing extravasation.

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    Patient consent for publication

    References

    1. ↵
      2. Hargitai B ,
      3. Toldi G ,
      4. Marton T , et al
      . Pathophysiological mechanism of extravasation via umbilical venous catheters. Pediatr Dev Pathol 2019;22:340–3.doi:10.1177/1093526619826714 pmid:http://www.ncbi.nlm.nih.gov/pubmed/30683018
      OpenUrlCrossRefPubMed
    2. ↵
      2. Baker J ,
      3. Imong S
      . A rare complication of neonatal central venous access. Arch Dis Child Fetal Neonatal Ed 2002;86:61F–2.doi:10.1136/fn.86.1.F61 pmid:http://www.ncbi.nlm.nih.gov/pubmed/11815552
      OpenUrlAbstract/FREE Full Text
    3. ↵
      2. Reece A ,
      3. Ubhi T ,
      4. Craig AR , et al
      . Positioning long lines: contrast versus plain radiography. Arch Dis Child Fetal Neonatal Ed 2001;84:129F–30.doi:10.1136/fn.84.2.F129 pmid:http://www.ncbi.nlm.nih.gov/pubmed/11207231
      OpenUrlAbstract/FREE Full Text
    4. ↵
      1. British Association of Perinatal Medicine 2020
      . Use of central venous catheters in neonates, 2018.

    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors JDT: writing up the report and obtaining parental consent. SRK: writing up the report. MK: named consultant, writing up the report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.