Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter

Marcos Moura de Almeida,Wládia Gislaynne de Sousa Tavares,Maria Marcia Farias Trajano Fontenele,Maria Mônica Alencar Araripe Furtado

doi:10.1016/j.rppede.2015.10.002

Marcos Moura de Almeida, Wládia Gislaynne de Sousa Tavares + Show 2 more

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https://doi.org/10.1016/j.rppede.2015.10.002

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Abstract

ObjectiveTo describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject. Case descriptionA late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied. CommentsThe association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death.

Highlights

Atrial flutter is a rare arrhythmia in the neonatal period
Catheters that go beyond the right atrium can get lodged in the superior vena cava, right ventricle, but usually pass through the foramen ovale and become lodged in the left atrium, which can lead to endocardial injury.[4]
The aim of this article is to report a case of an large for gestational age (LGA) newborn, born to a diabetic mother, who developed atrial flutter after the placement of an intracardiac umbilical venous catheter, reporting the clinical outcome and performing a brief literature review on the topic

Summary

Introduction

Umbilical catheterization is commonly used in neonatal management for the administration of parenteral nutrition, hypertonic solutions, blood products, blood pressure monitoring and medication infusion. This procedure, easy to perform, has potential risks, including catheter-related infection, thrombosis, myocardial perforation, pleural and pericardial effusions and arrhythmias.[3] Catheters should ideally be positioned between the inferior vena cava and the right atrium. Catheters that go beyond the right atrium can get lodged in the superior vena cava, right ventricle, but usually pass through the foramen ovale and become lodged in the left atrium, which can lead to endocardial injury.[4] The association between umbilical venous catheterization and cardiac arrhythmias is mainly reported when the catheter is misplaced, in an intracardiac position.4---8

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