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Incidence and identification of inadvertent lumbar vein catheterisation in the NICU
  1. Sajeev Job1,
  2. Sudeep Damodaran1,
  3. Peter Brooke1,
  4. Jonathan Mo2,
  5. Fred Pickworth2,
  6. Paul Clarke1
  1. 1 Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  2. 2 Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  1. Correspondence to Dr Paul Clarke, Neonatal Intensive Care Unit, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK; paul.clarke{at}nnuh.nhs.uk

http://dx.doi.org/10.1136/archdischild-2014-307095

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    A potential complication of percutaneously inserted central venous catheters (PCVCs) is inadvertent lodgement in an ascending lumbar vein (ALV; figure 1). Associated morbidities include epidural extravasation of parenteral nutrition, seizures, quadriplegia and death.1 The incidence of ALV catheter malposition is unknown. We aimed to (1) determine the incidence of ALV catheter malposition in our neonatal intensive care unit (NICU) and (2) survey current UK practices regarding use of radiopaque contrast for checking PCVC position.

    Figure 1

    Catheter malposition in left ascending lumbar vein (ALV) readily indicated by classical spiral-patterned vertebral venogram seen after contrast injection. Note also the kinking of the catheter in the iliac vein.

    We routinely inject radiopaque contrast medium (0.2–0.3 mL of Omnipaque 300 mg iodine/mL; GE Healthcare) to verify PCVC position and record details of all PCVCs inserted into a bespoke electronic database. We interrogated this database for cases of suspected ALV malposition and cross-referenced with a separate, prospectively maintained list …

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    Footnotes

    • Contributors PC conceived and designed the study. PC, SJ, PB and SD acquired the data. SJ and SD conducted the telephone survey. JM and FP reviewed the radiographs. PC and SJ analysed the data and wrote the manuscript. All authors contributed to manuscript revision and approved the final version.

    • Competing interests None.

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