Umbilical venous catheter (UVC) related extravasation is an under recognised yet potentially catastrophic complication. 1 A series of near fatal UVC extravasations prompted a retrospective study of UVC’s placed between April 2011 and July 2013.Method
All extravasations diagnosed clinically or by ultrasound with a UVC in situ underwent root cause analysis looking at placement, infusions imaging, symptomatology, and outcome after treatment. A simulated access workshop was piloted in September 2012 and posters addressing measurement, radiology and best practice were implemented in April 2013.Results
In 2012, 161 UVC’s were placed, of which 7 extravasated (4.3%). In 2013, 3 cases of extravasation occurred till June with no further cases to date. An analysis of 16 cases reveals 100% were double lumen catheters. 87% had TPN running through them. In all the babies, the UVC tip was well below the diaphragm at the time of extravasation. 25% had multiple attempts at UVC insertion. 69% babies had inotropes and/or sodium bicarbonate administered through the UVC. 20% of babies had no symptoms and in the remaining cases symptoms were subtle and nonspecific. 2 cases were near fatal.Conclusion
The majority of UVC extravasations were associated with hypertonic solutions running through catheters in a low position where blood flow is slower predisposing to this complication. Symptoms can be subtle necessitating a high index of suspicion. Early ultrasound is key and prompt catheter removal results in spontaneous improvement. A quality improvement exercise involving simulated umbilical access and posters to highlight best practice and complications have helped reduce this complication.