This case takes place in North Carolina and involves a pregnant woman who presented to the hospital with preliminary signs of labor, at which point she was admitted for observation. She experienced vaginal bleeding for a significant amount of time, and eventually the decision was made to induce labor. The baby was successfully delivered, and an umbilical catheter was placed. After some time, it was discovered that the baby was bleeding from a perforation of one of his major internal organs made by the tip of the umbilical catheter. In spite of heroic efforts to revive the baby, he eventually succumbed to his wounds and died.
Question(s) For Expert Witness
- 1. How often do you place umbilical catheters in infants?
- 2. What measures should be taken to prevent injury to internal organs when placing these devices?
- 3. What monitoring is required to ensure good placement of an umbilical catheter?
Expert Witness Response E-001331
Umbilical catheters are a common means of arterial and venous access for very preterm infants. At least 50% of infants born at 28 weeks gestation undergo UVC +/- UAC placement shortly after birth – a number higher in those that are small for gestational age or requiring significant respiratory or blood pressure support. While use of umbilical catheters are common in NICU’s, they are not without complications. After careful sterile placement of the catheter, its accuracy of placement must be determined prior to use, first by checking for blood return, then by abdominal xray or ultrasound. Infants with umbilical catheters must be monitored closely and handled carefully, as migration of the catheter tip may occur. If there is any change in the infant’s status, especially abdominal distenion, then location of the catheter must be verified. If it is in the liver or an extraluminal location, then it needs emergent attention. The consequences can be severe, as it appears to have been in this unfortunate case.