In-Situ umbilical venous catheterization replacement guided by guide wire through side hole in a preterm infant

Complications may occur in umbilical venous catheterization, such as catheter rupture and vascular perforation. Here we report a case of in-situ ruptured umbilical venous catheterization replacement guided by guide wire through side hole in a preterm female infant. She had a birth weight of 625 g and gestational age of 27+5wk, was admitted to the hospital due to respiratory distress syndrome after birth, and underwent umbilical venous catheterization. However, there was a slight rupture at the catheter end after 5 d, posing a risk of infection and thrombosis. Therefore, we attempted to perform umbilical venous catheterization replacement in-situ, guided by guide wire from the peripherally inserted central catheter package. Furthermore, each umbilical venous catheter had a blind tip and two side holes at a distance of 4 mm and 10 mm from the tip, respectively. So we bent the heparinized guide wire tip gently to a 150-degree arc, penetrated it into the original catheter tail, slowly pushed forward and rotated the catheter or guide wire. Finally, we successfully penetrated the guide wire through side hole and then removed the original catheter. Next, the guide wire tail was inserted through the side hole near the tip of a new catheter. As the catheter tip formed a certain angle with the guide wire, slight force was required to enter the residual end of the umbilical vein, with a slightly right tilted insertion direction after entering to prevent puncturing the umbilical vein. During the process, the catheters and guide wire were full heparinized and the residual umbilical cord was pinched to prevent forming embolism. Finally, we successfully placed the new catheter in the correct position (Supplementary Video). There have been no similar reports before and neonatologists can serve this as a reference when facing complex umbilical venous catheterization accidents.

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