Cateteres umbilicais em recém-nascidos: indicações, complicações e diagnóstico por imagem
DOI:
https://doi.org/10.15448/1980-6108.2015.1.19236Palavras-chave:
Cateteres, Radiografia, Ultrassonografia, Recém-nascido, Cuidados intensivos.Resumo
Objetivos: Revisar os últimos dados de literatura acerca do cateterismo umbilical quanto a indicações, complicações e diagnóstico de sua localização através de exames de imagem.
Métodos: Foram pesquisados artigos nas bases de dados PubMed, SciELO e LILACS, através dos seguintes descritores, assim como dos termos correspondentes em inglês: cateteres umbilicais; exame radiológico; ultrassonografia; recém-nascido; e cuidados intensivos neonatais. Foram incluídos também livros texto clássicos em literatura neonatal.
Resultados: Foram selecionados 51 artigos, quatro livros texto e um manual versando sobre cateteres umbilicais venosos e arteriais em recém-nascidos. Revisamos indicações, novas técnicas de inserção, complicações associadas, fatores de risco e diagnóstico por imagem, com ênfase nas referências anatômicas utilizadas para o diagnóstico da posição da extremidade do cateter.
Conclusões: O cateterismo umbilical representa um importante acesso à corrente sanguínea do recém-nascido e o diagnóstico por imagem desempenha um papel fundamental na avaliação correta do seu posicionamento, possibilitando, em caso de mau posicionamento, a conduta imediata para prevenção de complicações.
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Referências
Brasil. Ministério da Saude. Atenção à saúde do recém-nascido: guia para profissionais de saúde. Intervenções comuns, icterícia e infecções. Brasília (DF); 2011.
Bradshaw WT, Furdon AS. A nurse's guide to early detection of umbilical venous catheter complications in infants. Ad Neonatal Care. 2006;6:127-38. http://dx.doi.org/10.1016/j.adnc.2006.03.002
Figueiredo Junior I, Lima GM. O conhecimento de neonatologistas relativo a técnicas de posicionamento de cateteres umbilicais. Pediatria (São Paulo). 2004;26(2):85-9.
Verheij GH, te Pas AB, Smits-Wintjens VE, Šràmek A, Walther FJ, Lopriore E. Revised formula to determine the insertion length of umbilical vein catheters. Eur J Pediatr. 2013;172(8):1011-5. http://dx.doi.org/10.1007/s00431-013-1981-z
Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics. 2006;118:e25-35. http://dx.doi.org/10.1542/peds.2005-1880
MacDonald MG, Mullett Md, Seshia MMK. Avery's Neonatology: pathophysiology & management of the newborn. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
Hermansen MC, Hermansen MG. Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol. 2005;32(1):141-56. http://dx.doi.org/10.1016/j.clp.2004.11.005
Yiğiter M, Arda IS, Hiçsönmez A. Hepatic laceration because of malpositioning of the umbilical vein catheter: case report and literature review. J Pediatr Surg. 2008;43(5):E39-41. http://dx.doi.org/10.1016/j.jpedsurg.2008.01.018
Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr. 2013;102(7):e293-8. http://dx.doi.org/10.1111/apa.12256
Beluffi G, Perotti G. Where has the umbilical catheter gone? An unusual position. Pediatr Radiol. 2007;37(4):403. http://dx.doi.org/10.1007/s00247-006-0377-x
Eifinger F, Brisken K, Roth B, Koebke J. Topographical anatomy of central venous system in extremely low-birth weight neonates less than 1000 grams and the effect of central venous catheter placement. Clin Anat. 2011;24(6):711-6. http://dx.doi.org/10.1002/ca.21204
Grupo de Hospitales Castrillo. Studio prospectivo sobre el empleo de cateteres umbilicales em el récien nascido. An Esp Pediatr. 2000;53:470-78. http://dx.doi.org/10.1016/S1695-4033(00)78631-0
Nemri AMA, Inacio LC, Zamil FAA, Jarallah ASA. Rare but fatal complication of umbilical venous catheterization. Congenit Heart Dis. 2006;1(4):180-3. http://dx.doi.org/10.1111/j.1747-0803.2006.00031.x
Greenberg M, Movahed H, Peterson B, Bejar R. Placement of umbilical venous catheters with use of bedside real–time ultrasonography. J Pediatr. 1995;126(4):633-5. http://dx.doi.org/10.1016/S0022-3476(95)70366-7
Lussky RC. Radiology casebook. Unusual misplacement sites for central venous catheters: three case reports. J Perinatol. 2000;20(8):562-4. http://dx.doi.org/10.1038/sj.jp.7200462
Hogan MJ. Neonatal vascular catheters and their complications. Radiol Clin North Am. 1999;37(6):1109-25. http://dx.doi.org/10.1016/S0033-8389(05)70252-9
Campbel RE. Roentgenologic features of umbilical vascular catheterization in the newborn. Am J Roentgenol Radium Ther Nucl Med. 1971;112(1):68-76. http://dx.doi.org/10.2214/ajr.112.1.68
Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010;98(4):381-6. http://dx.doi.org/10.1159/000316918
Wright IMR, Owers M, Wagner M. The umbilical arterial catheter: a formula for improved positioning in the very low birth weight infant. Pediatr Crit Care Med. 2008;9(5):498-501. http://dx.doi.org/10.1097/PCC.0b013e318172d48d
Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986;140:786-8. http://dx.doi.org/10.1001/archpedi.1986.02140220068034
Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child. 1966;41(215):69-75. http://dx.doi.org/10.1136/adc.41.215.69
Slovis TL, editor. Caffey's Pediatric Diagnostic Imaging. 11th ed. Pennsylvania: Mosby Elsevier; 2008.
Furdon SA, Horgan MJ, Bradshaw WT, Clark DA. Nurses' guide to early detection of umbilical arterial catheter complications in infants. Adv Neonatal Care. 2006;6(5):242-60. http://dx.doi.org/10.1016/j.adnc.2006.06.001
Imamura T, Momoi N, Go H, Ogasawara K, Kanai Y, Sato M, Goto A, Hosoya M. Evaluation of arterial catheter management in very preterm neonates: peripheral artery versus umbilical artery. Fukushima J Med Sci. 2012;58(1):1-8. http://dx.doi.org/10.5387/fms.58.1
Coleman MM, Spear ML, Finkelstein M, Leef KH, Pearlman SA, Chien C, Taylor SM, McKenzie SE. Short term use of umbilical artery catheters may not be associated with increased risk of thrombosis. Pediatrics. 2004;113(4):770-4. http://dx.doi.org/10.1542/peds.113.4.770
Demirel N, Aydin M, Zenciroglu A, Bas AY, Yarali N, Okumus N, Cinar G, Ipek S. Neonatal thrombo-embolism: risk factors, clinical features and outcome. Ann Trop Paediatr. 2009;29(4):271-9. http://dx.doi.org/10.1179/027249309X12547917868961
Narang S, Roy J, Stevens TP, Butler-O'Hara M, Mullen CA, D'Angio CT. Risk factors for umbilical venous catheter-associated thrombosis in very low birth weight infants. Pediatr Blood Cancer. 2009;52(1):75-9. http://dx.doi.org/10.1002/pbc.21714
Boo NY, Wong NC, Zulkifli SS, Lye MS. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health. 1999;35(5):460-5. http://dx.doi.org/10.1046/j.1440-1754.1999.355392.x
Kim JH, Lee YS, Kim SH Lee SK, Lim MK, Kim HS. Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology. 2001;219(3):645-50. http://dx.doi.org/10.1148/radiology.219.3.r01jn17645
Morag I, Epelman M, Daneman A, Moineddin R, Parvez B, Shechter T, Hellmann J. Portal vein thrombosis in the neonate: risk factors, course, and outcome. J Pediatr. 2006;148(6):735-9. http://dx.doi.org/10.1016/j.jpeds.2006.01.051
Kirpalani H, Mernagh J, Epelman M. Imaging of the Newborn. Cambridge: Cambridge University Press; 2011. http://dx.doi.org/10.1017/CBO9780511978074
Schlapbach LJ, Pfammatter JP, Nelle M, McDougal FJ. Cardiomegaly in a premature neonate after venous umbilical catheterisation. Eur J Pediatr. 2009;168(1):107-9. http://dx.doi.org/10.1007/s00431-008-0704-3
Onal EE, Saygili A, Koç E, Türkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe? Paediatr Anaesth. 2004;14(11):953-6. http://dx.doi.org/10.1111/j.1460-9592.2004.01385.x
Verheij G, Smits-Wintjens V, Rozendaal L, Blom N, Walther F, Lopriore E. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates. BMJ Case Rep. 2009;2009. http://dx.doi.org/10.1136/bcr.04.2009.1778
Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA, editors. Infectious Diseases of the Fetus and Newborn Infant. 7th ed. Pennsylvania: Elsevier Saunders; 2011.
Chung DH, Ziegler MM. Central venous catheter access. Nutrition. 1998;14(1):119-23. http://dx.doi.org/10.1016/S0899-9007(97)00228-1
Yalaz M, Altun-Köroğlu O, Ulusoy B, Yildiz B, Akisu M, Vardar F, Ozinel MA, Kültürsay N. Evaluation of device-associated infections in a neonatal intensive care unit. Turk J Pediatr. 2012;54(2):128-35.
Bothur-Nowacka J, Czech-Kowalska J, Gruszfeld D, Nowakowska-Rysz M, Kościesza A, Polnik D, Dobrzańska A. Complications of umbilical vein catherisation. Case Report. Pol J Radiol. 2011;76(3):70-3.
Costa S, Carolis MPD, Savarese I, Manzoni C, Lacerenza S, Romagnoli C. An unusual complication of umbilical catheterisation. Eur J Pediatr. 2008;167(12):1467-9. http://dx.doi.org/10.1007/s00431-008-0691-4
Mogbo KI, Wang DC. Biliary venous fistula from umbilical catheter placement. Pediatr Radiol. 1997;27(4):333-5. http://dx.doi.org/10.1007/s002470050143
Alvares BR, Stopiglia MCS, Mezzacappa MA. Presence of air in the hepatic portal system in association with umbilical venous catheter malposition. Radiol Bras. 2014;47(1):49-50. http://dx.doi.org/10.1590/S0100-39842014000100015
Houston AB, Garg AK, Maclaurin JC, Mackenzie JR. Ultrasound positioning of umbilical arterial catheters. Lancet. 1982;2(8301):759. http://dx.doi.org/10.1016/S0140-6736(82)90934-5
Garg AK, Houston AB, Laing JM, Mackenzie JR. Positioning of umbilical arterial catheters with ultrasound. Arch Dis Child. 1983;58(12):1017-8. http://dx.doi.org/10.1136/adc.58.12.1017
Michel F, Brevaut-Malaty V, Pasquali R, Thomachot L, Vialet R, Hassid S, Nicaise C, Martin C, Panuel M. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation. 2012;83(6):705-9. http://dx.doi.org/10.1016/j.resuscitation.2011.11.026
Simanovsky N, Ofek-Shlomai N, Rozovsky K, Ergaz-Shaltiel Z, Hiller N, Bar-Oz B. Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol. 2011;21(9):1882-6. http://dx.doi.org/10.1007/s00330-011-2129-z
Bayhan C, Takci S, Çiftçi TT, Yurdakök M. Sterile hepatic abscess due to umbilical venous catheterization. Turk J Pedriatr. 2012; 54:671-3.
Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010;98(4):381-6. http://dx.doi.org/10.1159/000316918
Schelesinger AE, Braverman RM, DiPietro MA. Neonates and umbilical venous catheters: normal appearance, anomalous positions, complications, and potential aid to diagnosis. AJR Am J Roentgenol. 2003;180:1147-53. http://dx.doi.org/10.2214/ajr.180.4.1801147
Narla LD, Hom M, Lofland GK. Evaluation of umbilical catheter and tube placement in premature infants. Radiographics. 1991;11(5):849-63. http://dx.doi.org/10.1148/radiographics.11.5.1947320
Radiology in the nursery – indications, positioning and safety. [Internet]. Los Angeles; 2013 [cited 2013 June]. Available from: http://paclac.org/guidelines-care/#neonatal
Peck DR. Lowman RM. Roentgen aspects of umbilical vascular catheterization in the newborn. The problems of catheter placement. Radiology. 1967;89(5):874-7. http://dx.doi.org/10.1148/89.5.874
Baker DH, Berdon WE, James LS. Proper localization of umbilical arterial and venous catheters by lateral roentgenograms. Pediatrics. 1969;43(1):142-3.
Alvares BR, Pereira ICMR, Araujo Neto SA, Skuma ETI. Achados normais no exame radiológico de tórax do recém-nascido. Radiol Bras. 2006;39(6):435-440. http://dx.doi.org/10.1590/S0100-39842006000600012
Campbel RE. Roentgenologic features of umbilical vascular catheterization in the newborn. Am J Roentgenol Radium Ther Nucl Med. 1971;112(1):68-76. http://dx.doi.org/10.2214/ajr.112.1.68
Seguin J, Fletcher MA, Landers S. Umbilical venous catheterizations: audit by the study group for complications perinatal care. Am J Perinatol. 1994; 11:67-70. http://dx.doi.org/10.1055/s-2007-994540
Oestreich AE. Umbilical vein catheterization-appropriate and inappropriate placement. Pediatr Radiol. 2010;40(12):1941-9. http://dx.doi.org/10.1007/s00247-010-1840-2
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