Hi there,

I recently have a discussion with my colleagues about the risks involved in managing neonates with below the liver UVC and running TPN through it. I could not find case reports that enlighten a better science. I would like to hear your opinion about this topic. What is your practice? 1. do you use low-line UVC to administer TPN? have you ever had any liver injury from TPN extravasation? if you use TPN in low-line UVC, is there any osmolarity you feel safe with? what about Ca in the TPN, do you use it regularly on low-line UVC?

Thanks your your responses

v/r

Dr. Guerra

I will keep posting links as I keep getting them.

http://radiology.rsna.org/content/219/3/645.full

...we compared the incidence of portal venous thrombosis between the groups with the catheter tip above (high group) and those with the catheter tip below (liver or low group) the level of the diaphragm (approximate junction of the inferior vena cava and the right atrium at conventional radiography)....Second, the group with an umbilical venous catheter that traversed the liver (traverse group, liver or high) was compared with the group with an umbilical venous catheter that did not traverse the liver (nontraverse group, low)......

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043016/

...Low positioning of the umbilical vein catheter tip appeared to be a second contributory factor...

http://www.sswahs.nsw.gov.au/rpa/neonatal/html/newprot/uvc.html

"...An UVC with the tip in an intermediate or low position should not usually be left in situ for more than 48-72 hours unless the clinical situation is critical and there is no alternative secure venous access...."

If we can't get the UVC into a high position, we remove it and insert a PICC line, within 24 hours if possible.

http://m.adc.bmj.com/content/99/Suppl_1/A91.2