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Published on: September 22, 2020
Lower extremity ischemia following umbilical artery catheterization: a case study and clinical update
Samuel J Lin1, Peter F Koltz, Wellington Davis
1Division of Pediatric Plastic Surgery, Department of Surgery, Children's Memorial Hospital, Chicago, IL, USA. samjlin@hotmail.com
Abstract:
In the neonatal intensive care unit, the use of umbilical artery catheters (UAC) is established. Methods to perform uninterrupted arterial blood gas and pressure monitoring, access for the delivery of fluids and medication, exchange transfusion, cardiac catheterization, and angiography using umbilical artery catheters are used in the care of critically ill neonatal patients. One complication that can develop with the use of UAC's is lower limb ischemia, which can result in catastrophic effects, including limb amputation. In selected cases, conservative management may be an option in patients for limb salvage in the setting of lower limb ischemia. In this paper, we present a case study of a patient who developed lower limb ischemia during UAC who was treated conservatively. This approach resulted in limb salvage and avoidance of lower extremity amputation. The literature was reviewed for relevant risk factors and treatment options for lower limb ischemia following umbilical artery catheterization.
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Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
