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Umbilical venous catheterisation: emergency central venous access which saves lives in coarctation of the aorta
  1. Amber Seigel1,
  2. Nele Legge2,
  3. Gerry Hughes3 and
  4. Kathryn Browning Carmo1,4,5
  1. 1Newborn & Paediatric Emergency Transport Service, Sydney Children's Hospitals Network, Sydney, NSW, Australia
  2. 2Newborn Care, Liverpool Hospital, Liverpool, New South Wales, Australia
  3. 3Paediatric Intensive Care Unit 1, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland
  4. 4Grace Centre for Newborn Intensive Care, Children's Hospital at Westmead, Sydney, NSW, Australia
  5. 5Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  1. Correspondence to A/Prof Kathryn Browning Carmo; kath.carmo{at}nets.health.nsw.gov.au

Abstract

We describe a 9-day-old baby with coarctation of the aorta who required urgent resuscitation including intubation and cardiac compressions. Despite the commencement of prostaglandin E1 (PGE1) to reopen the ductus arteriosus via the intraosseous route, postductal saturations remained unrecordable for a further 45 min. Within 3 min of administration of PGE1 via an umbilical venous catheter (UVC), saturations were recordable at 92%. UVC access was the sentinel intervention that irrevocably altered the clinical prognosis. This baby boy has survived with excellent neurodevelopmental outcome. Clinicians are less familiar with UVCs outside of the newborn period. Our data demonstrate successful placement in neonates up to 28 days of age. We hope this case encourages clinicians to consider the UVC as first-line central venous access in collapsed neonates. In cases of suspected left heart obstruction, we argue that UVCs are the optimal route.

  • emergency medicine
  • resuscitation
  • heart failure
  • neonatal and paediatric intensive care

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Footnotes

  • Twitter @kathryc4

  • Contributors AS: responsible for writing case report, preparing submission and resubmission, reviewing relevant literature and manuscript and liaising with the patient’s family; approves version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NL: responsible for obtaining ethics approval for audit of umbilical venous catheter (UVC) use, analysis and interpretation of audit data, reviewing relevant literature, reviewing manuscript; approves version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GH: responsible for reviewing manuscript; substantial contributions to the conception and writing of report; approves version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KBC: responsible for conception of audit of UVC audit and case report, analysis and interpretation of audit data and reviewing manuscript and edits; final approval of the version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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