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Retained umbilical artery catheter presenting as an umbilical abscess
  1. R KOTNIS,
  1. Department of Paediatric Surgery, John Radcliffe Hospital, Oxford

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Editor—We report the delayed recognition of an umbilical artery catheter in an 18 month infant who presented with recurrent umbilical discharge.

A male infant was delivered by caesarian section which was complicated by a hypoglycaemic fit. Resuscitation included the attempted insertion of an umbilical venous catheter. The line was found to be arterial and thus removed. A second attempt also entered the umbilical artery, and, as the infant was now stable, no further attempt was made.

At 15 months, the infant presented with an umbilical abscess. This was investigated after drainage to exclude a urachal remnant. An ultrasound and abdominal radiograph showed a foreign body within the common iliac artery, and, using an infraumbilical approach, part of an umbilical catheter was removed. The remnant was 10 cm in length.

During the neonatal period, the umbilicus is a useful route of vascular access. The umbilical artery can be used for blood pressure and gas tension measurement but all catheters should be removed early to avoid central infection.1 Other complications such as thrombosis and necrotising enterocolitis have been reported.2Migration of umbilical vein catheters into the left atrium and pulmonary veins may occur.3 Retrieval of fractured umbilical catheters during the neonatal period has been reported.4

In this case, the retained catheter was not recognised until the infant presented late with recurrent umbilical infections and illustrates a new addition to our list of differential diagnoses. The history also re-emphasises that it is essential to check central lines for completeness on removal.