PubMed · 8117140
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D T Hindley, M A Lewis, M J Robinson. 1994. Method for securing umbilical lines.. https://doi.org/10.1136/fn.70.1.f79-a
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Thromboembolic occlusions of peripheral arteries may threaten the vitality of extremities and sometimes patients life. Till recently the main therapeutic method was Fogarty surgical thromboembolectomy. A less invasive procedure is systemic (intravenous) and local (intraarterial) thrombolysis. All these method have, however, certain disadvantages. A new approach to the treatment for acute and subacute occlusions of peripheral arteries represents catheter thromboembolectomy, which involves the following: a) Aspiration of thromboembolic material--percutaneous thrombembolextraction (PTEE), b) Local infiltration thrombolysis where the catheter penetrates through the occlusion while simultaneously administering a fibrinolytic agent, c) PTA of residual stenosis in case of thrombotic occlusion. A combination of these methods of treatment for thromboembolic occlusions of peripheral arteries is very effective and enables to use a small amount of thrombolytic agent. The thrombosis and the underlying atherosclerotic stenosis are resolved during the same session.
The pathway of the radial artery of 23 patients, ranging in age from 17 days to 10 years, was located with a small-caliber Doppler probe, 1.5 mm in diameter, and the artery was punctured along the pathway traced on the skin surface. In all patients the arterial pathway, including its branch and diameter, was shown clearly. In 11 patients, ranging in weight from 5 to 24 kg, the artery was greater than 0.5 mm in diameter and was cannulated easily. In another 4 patients, all less than 3 kg in weight, the artery under the thin skin layer was cannulated successfully in three of them. However, among the remaining 8 patients, ranging in weight from 3 to 5 kg, cannulation was successful in only two cases. The thick tissue layer, including the skin and the subcutaneous layer over the small artery, was thought to interfere with the accurate location of the artery in the other six patients. Nevertheless, the arterial pathway traced on the skin surface facilitated successful percutaneous cannulation by another method in these six. Visualization of the arterial pathway by the small-caliber Doppler probe was thought to be helpful for percutaneous cannulation, with or without another cannulation method.
Umbilical venous catheters that are pushed in too far will usually cross the atrial septum and may dislodge in a pulmonary vein. The authors report eight neonates with radiographic documentation of this catheter malposition together with either a localized pulmonary opacification or an autopsy report of a pulmonary hemorrhage or infarction corresponding to the catheter position. The lung injury ranged from a transient edema to hemorrhagic pulmonary infarction and hydrothorax. In two cases autopsy demonstrated localized infarction without previous radiographic signs of catheter-related injury.