PDF herunterladen
Am J Perinatol 2014; 31(11): 965-974
DOI: 10.1055/s-0034-1370346
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Severe Liver Injury while Using Umbilical Venous Catheter: Case Series and Literature Review

Ruza Grizelj
1   Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia
,
Jurica Vukovic
1   Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia
,
Katarina Bojanic
2   Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
,
Damir Loncarevic
1   Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia
,
Ranka Stern-Padovan
3   Department of Radiology, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia
,
Boris Filipovic-Grcic
1   Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia
,
Toby N. Weingarten
4   Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
,
Juraj Sprung
4   Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
› Institutsangaben
Weitere Informationen

Publikationsverlauf

22. November 2013

31. Dezember 2013

Publikationsdatum:
03. März 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Objective Proper position of umbilical venous catheter (UVC) is of importance to avoid severe complications. We review clinical presentations of neonates with UVC who developed catheter-associated liver injury.

Study Design We reviewed institutional intensive care database (2008–2013) and identified neonates with UVCs who developed severe hepatic injury. We recorded admission diagnosis, gestational age, birth weight, number of days the umbilical catheter was in place, its radiological position at insertion and at the time of injury, presenting clinical signs, and outcomes.

Results Of 1,081 neonates, 9 (0.8% [95% exact binomial confidence interval, 0.4–1.6%]) with UVC developed severe hepatic injury. All had the UVC malpositioned within the liver circulation. All presentations were life threatening, with acute abdominal distension (hepatomegaly) being the most consistent sign. Two neonates died from complications which were unrelated to catheter-associated liver injury.

Conclusions : In all neonates with liver injury, UVC was malpositioned within the portal circulation. Despite the fact that our report provides only circumstantial evidence for the mechanism of injury, it supports reports which suggest that “low” UVC position increases potential for this type of complication. Acute onset of abdominal distension in a neonate with UVC should prompt ultrasonographic evaluation of position of the catheter tip.

Keywords

catheter malposition - complications - liver injury - thoracoabdominal radiographs - ultrasonography - umbilical venous catheter
 

  • References

  • 1 Williams S, Chan AKC. Neonatal portal vein thrombosis: diagnosis and management. Semin Fetal Neonatal Med 2011; 16 (6) 329-339
    CrossrefPubMedSuche in Google Scholar
  • 2 Coley BD, Seguin J, Cordero L, Hogan MJ, Rosenberg E, Reber K. Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters. Pediatr Radiol 1998; 28 (12) 923-927
    CrossrefPubMedSuche in Google Scholar
  • 3 Gülcan H, Hanta D, Törer B, Temiz A, Demir S. Hepatic laceration as a life-threatening complication of umbilical venous catheterization. Turk J Pediatr 2011; 53 (3) 342-345
    PubMedSuche in Google Scholar
  • 4 Hui JYH, Lo KKL, Lo J, Chan MLM, Chan JCS. Neonatal total parenteral nutrition ascites secondary to umbilical venous catheterization. Hong Kong J Radiol 2001; 4: 288-290
    PubMedSuche in Google Scholar
  • 5 Lam HS, Li AM, Chu WC, Yeung CK, Fok TF, Ng PC. Mal-positioned umbilical venous catheter causing liver abscess in a preterm infant. Biol Neonate 2005; 88 (1) 54-56
    CrossrefPubMedSuche in Google Scholar
  • 6 Lee SH, Tomlinson C, Temple M, Amaral J, Connolly BL. Imaging-guided percutaneous needle aspiration or catheter drainage of neonatal liver abscesses: 14-year experience. AJR Am J Roentgenol 2008; 190 (3) 616-622
    CrossrefPubMedSuche in Google Scholar
  • 7 Levkoff AH, Macpherson RI. Intrahepatic encystment of umbilical vein catheter infusate. Pediatr Radiol 1990; 20 (5) 360-361
    CrossrefPubMedSuche in Google Scholar
  • 8 Lim-Dunham JE, Vade A, Capitano HN, Muraskas J. Characteristic sonographic findings of hepatic erosion by umbilical vein catheters. J Ultrasound Med 2007; 26 (5) 661-666
    PubMedSuche in Google Scholar
  • 9 Mahajan V, Rahman A, Tarawneh A, Sant'anna GM. Liver fluid collection in neonates and its association with the use of a specific umbilical vein catheter: report of five cases. Paediatr Child Health (Oxford) 2011; 16 (1) 13-15
    PubMedSuche in Google Scholar
  • 10 Panetta J, Morley C, Betheras R. Ascites in a premature baby due to parenteral nutrition from an umbilical venous catheter. J Paediatr Child Health 2000; 36 (2) 197-198
    PubMedSuche in Google Scholar
  • 11 Rejjal AR, Galal MO, Nazer HM, Karim AA, Osba YA. Complications of parenteral nutrition via an umbilical vein catheter. Eur J Pediatr 1993; 152 (7) 624
    PubMedSuche in Google Scholar
  • 12 Schlesinger AE, Braverman RM, DiPietro MA. Pictorial essay. Neonates and umbilical venous catheters: normal appearance, anomalous positions, complications, and potential aid to diagnosis. AJR Am J Roentgenol 2003; 180 (4) 1147-1153
    CrossrefPubMedSuche in Google Scholar
  • 13 Sethi SK, Dewan P, Faridi MM, Aggarwal A, Upreti L. Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catheterisation in two neonates. Trop Gastroenterol 2007; 28 (2) 79-80
    PubMedSuche in Google Scholar
  • 14 Shareena I, Khu YS, Cheah FC. Intraperitoneal extravasation of total parental nutrition infusate from an umbilical venous catheter. Singapore Med J 2008; 49 (2) e35-e36
    PubMedSuche in Google Scholar
  • 15 Devlieger H, Snoeys R, Wyndaele L , et al. Liver necrosis in the new-born infant: analysis of some precipitating factors in neonatal care. Eur J Pediatr 1982; 138 (2) 113-119
    CrossrefPubMedSuche in Google Scholar
  • 16 Haase R, Hein M, Thäle V, Vilser C, Merkel N. Umbilical venous catheters—analysis of malpositioning over a 10-year period [in German]. Z Geburtshilfe Neonatol 2011; 215 (1) 18-22
    Thieme ConnectPubMedSuche in Google Scholar
  • 17 Oestreich AE. Umbilical vein catheterization—appropriate and inappropriate placement. Pediatr Radiol 2010; 40 (12) 1941-1949
    Suche in Google Scholar
  • 18 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
    Suche in Google Scholar
  • 19 Greenberg M, Movahed H, Peterson B, Bejar R. Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr 1995; 126 (4) 633-635
    Suche in Google Scholar
  • 20 Michel F, Brevaut-Malaty V, Pasquali R , et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation 2012; 83 (6) 705-709
    CrossrefPubMedSuche in Google Scholar
  • 21 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
    Suche in Google Scholar
  • 22 Baysoy G, Uslu N, Balamtekin N , et al. Extrahepatic portal vein obstruction. The etiology, treatment options and prognosis. J Pediatr Gastroenterol Nutr 2010; 50: E144-E145
    PubMedSuche in Google Scholar
  • 23 Brans YW, Ceballos R, Cassady G. Umbilical catheters and hepatic abscesses. Pediatrics 1974; 53 (2) 264-266
    PubMedSuche in Google Scholar
  • 24 Cohen M, Sprigg A, Roberts I, Bustani P. Subcapsular haematoma and multifocal necrosis as fatal liver complications following umbilical vein catheterisation in a premature baby. Eur J Pediatr Surg 2006; 16 (1) 55-57
    Thieme ConnectPubMedSuche in Google Scholar
  • 25 Image interpretation session: 1995. Case 7. Hepatic hematoma and left portal vein thrombosis due to an inappropriately placed umbilical vein catheter. Radiographics 1996; 16 (1) 230-232 (no authors listed)
    CrossrefPubMedSuche in Google Scholar
  • 26 Yeung JTH, Lui DCY, Lee SY, Ma JKF, Fong JCY. Neonatal exchange transfusion complicated by haemoperitoneum and liver haematoma related to umbilical venous catheterization. Hong Kong J Radiol 2011; 14 (4) 244-248
    PubMedSuche in Google Scholar
  • 27 Yiğiter M, Arda IS, Hiçsönmez A. Hepatic laceration because of malpositioning of the umbilical vein catheter: case report and literature review. J Pediatr Surg 2008; 43 (5) E39-E41
    PubMedSuche in Google Scholar
  • 28 Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child 1986; 140 (8) 786-788
    PubMedSuche in Google Scholar
  • 29 Tariq AA, Rudolph N, Levin EJ. Solitary hepatic abscess in a newborn infant: a sequel of umbilical vein catheterization and infusion of hypertonic glucose solutions. Clin Pediatr (Phila) 1977; 16 (6) 577-578
    CrossrefPubMedSuche in Google Scholar
  • 30 Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics 2006; 118 (1) e25-e35
    CrossrefPubMedSuche in Google Scholar
  • 31 O'Grady NP, Alexander M, Dellinger EP , et al. Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S. Pediatrics 2002; 110 (5) e51
    CrossrefPubMedSuche in Google Scholar
  • 32 Evans N . RPA Newborn Care Guidelines. In: Royal Prince Alfred Hospital; 2011 . Available at: http://www.sswahs.nsw.gov.au/rpa/neonatal/html/docs/uvc.pdf . Accessed October 2013
    PubMed
  • 33 Moens E, Dooy JD, Jansens H, Lammens C, Op de Beeck B, Mahieu L. Hepatic abscesses associated with umbilical catheterisation in two neonates. Eur J Pediatr 2003; 162 (6) 406-409
    PubMedSuche in Google Scholar
  • 34 Montaruli E, Pfister RE, Wildhaber BE. Sterile hepatic abscess secondary to administration of parenteral fluids via an umbilical venous catheter in a premature baby. J Pediatr Gastroenterol Nutr 2011; 53 (5) 575-576
    CrossrefPubMedSuche in Google Scholar
  • 35 Singleton EB. Radiologic considerations of intensive care in the premature infant. Annual oration in honor of William Henry Neil, M.D., 1924-1972. Radiology 1981; 140 (2) 291-300
    CrossrefPubMedSuche in Google Scholar
  • 36 Vos LJ, Potocky V, Bröker FH, de Vries JA, Postma L, Edens E. Splenic vein thrombosis with oesophageal varices: a late complication of umbilical vein catheterization. Ann Surg 1974; 180 (2) 152-156
    CrossrefPubMedSuche in Google Scholar
  • 37 Puch-Kapst K, Juran R, Stoever B, Wauer RR. Radiation exposure in 212 very low and extremely low birth weight infants. Pediatrics 2009; 124 (6) 1556-1564
    CrossrefPubMedSuche in Google Scholar