Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography

Abstract

Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho) is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU), including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU.

Keywords

targeted neonatal echocardiography - umbilical venous catheter - low cardiac output - atrial septal defect

• References

• 1 Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 2001; 21 (5) 272-278
• 2 El-Khuffash AF, McNamara PJ. Neonatologist-performed functional echocardiography in the neonatal intensive care unit. Semin Fetal Neonatal Med 2011; 16 (1) 50-60
• 3 Sehgal A. Haemodynamically unstable preterm infant: an unresolved management conundrum. Eur J Pediatr 2011; 170 (10) 1237-1245
• 4 Evans N, Iyer P. Incompetence of the foramen ovale in preterm infants supported by mechanical ventilation. J Pediatr 1994; 125 (5 Pt 1) 786-792
• 5 Evans N, Kluckow M. Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 74 (2) F88-F94
• 6 Evans N, Iyer P. Assessment of ductus arteriosus shunt in preterm infants supported by mechanical ventilation: effect of interatrial shunting. J Pediatr 1994; 125 (5 Pt 1) 778-785
• 7 Ginghină C. The Coandă effect in cardiology. J Cardiovasc Med (Hagerstown) 2007; 8 (6) 411-413
• 8 Chao K, Moises VA, Shandas R, Elkadi T, Sahn DJ, Weintraub R. Influence of the Coanda effect on color Doppler jet area and color encoding. In vitro studies using color Doppler flow mapping. Circulation 1992; 85 (1) 333-341
• 9 Jain A, Sahni M, El-Khuffash A, Khadawardi E, Sehgal A, McNamara PJ. Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. J Pediatr 2012; 160 (4) 584-589
• 10 Carmo KB, Evans N, Paradisis M. Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography. J Pediatr 2009; 155 (6) 819-822
• 11 Subhedar NV, Hamdan AH, Ryan SW, Shaw NJ. Pulmonary artery pressure: early predictor of chronic lung disease in preterm infants. Arch Dis Child Fetal Neonatal Ed 1998; 78 (1) F20-F24
• 12 Ades A, Sable C, Cummings S, Cross R, Markle B, Martin G. Echocardiographic evaluation of umbilical venous catheter placement. J Perinatol 2003; 23 (1) 24-28
• 13 Raval NC, Gonzalez E, Bhat AM, Pearlman SA, Stefano JL. Umbilical venous catheters: evaluation of radiographs to determine position and associated complications of malpositioned umbilical venous catheters. Am J Perinatol 1995; 12 (3) 201-204
• 14 Jain A, McNamara PJ, Ng E, El-Khuffash A. The use of targeted neonatal echocardiography to confirm placement of peripherally inserted central catheters in neonates. Am J Perinatol 2012; 29 (2) 101-106
• 15 Ramasethu J. Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol 2008; 35 (1) 199-222
• 16 Mertens L, Seri I, Marek J , et al; Writing Group of the American Society of Echocardiography; European Association of Echocardiography; Association for European Pediatric Cardiologists. Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: practice guidelines and recommendations for training. Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). J Am Soc Echocardiogr 2011; 24 (10) 1057-1078