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Short term Use of umbilical Artery Catheters may not be Associated with Increased Risk For Thrombosis.Coleman MM, Spear ML, Finkelstein M et al. Pediatrics 2004;113:770-774
Reviewed by: Thomas J. Mancuso, MD, FAAP
This study was designed to determine prothrombin fragment (F1.2) and thrombin-antithrombin (TAT) levels over time and compare those levels with platelet counts and ultrasound evidence of UAC thrombi during the first week of life of sick newborns with UAC's. Infants who had UAC's placed within the first 24 hours of life were included. The study duration was five days. The investigation was a prospective, non-blinded, observational design that enrolled 33 newborns in a six-month period. In this group, only one ultrasound study was positive for an aortic thrombus, there was no significant change of F1.2 or TAT over time. The authors conclude that UAC' in sick newborns may not carry an increased risk of thrombus formation in the first five days of use.
Sick newborns come to the OR with indwelling UAC's and on occasion, placement of such a monitor is planned as part of the anesthetic care. This report is useful simply to alert us the possible, albeit rare complication the use of such a monitor has. This report does not specifically address the topic of location of the tip of the UAC but it is important to be aware of where, in the course of the very short aorta of the newborn the tip of the catheter lies. One dose not want to flush anything directly into the PDA, the renal arteries or mesenteric trunk.
It is known that the use of umbilical artery catheters is associated with the quite serious, but rare complication of thrombus formation. The true incidence is difficult to ascertain owing to two factors; the varied methods used to diagnose the problem and the timing of the search for the thrombus. Doppler sonography, aortography, and autopsy have all been used to investigate the problem of thrombosis. Reported incidence is often in the range of 1% but some investigations have had a much higher incidence. Further complicating interpretation of the data, studies have been prospective, others retrospective. Some investigators have reported that clot formation began only after catheter removal.
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