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Abstract

Background and aims: Umbilical venous catheter (UVC) related extravasation is an under recognised yet potentially catastrophic complication which can result in death. Prompt recognition requires a high index of suspicion. A couple of near fatal UVC extravasation (UVCE) prompted this study. Aims: To calculate incidence and identify etiopathogenesis of UVCE. Methods: A retrospective analysis of all UVCE, between April 2011 and July 2013, was carried out. UVCE were diagnosed clinically or by ultrasound. A simulated access workshop was implemented in September 2012. Using posters addressing best practice at point of care along with change of preterm Parenteral nutrition (PN) concentration from 13.4% to 10% were put in place from March 2013. This being an audit, IRB waived the need for written informed consent. Results: Incidence of UVCE in 2012 was 4.3% (n=7). Total 16 UVCE were identified, of which 100% were double lumen catheters with UVC tip below diaphragm at time of extravasation. 87% of these babies had PN running through the lines. The dextrose concentration in PN was 12.1–18.6 %. 69% babies had inotropes and/or sodium bicarbonate administered through UVC. In 81% babies, extravasation injury was symptomatic, the commonest presentation being abdominal distension (83%). 2 episodes were near fatal. Conclusions: The majority of UVCE were associated with hypertonic solutions running through catheters in a low position, where blood flow is slower, predisposing to this complication. Early ultrasound is key in diagnosis. Prompt removal of the line with improvement in symptoms is the norm. Education about proper UVC positioning and side effects along with using low PN concentration might help decrease UVCE.