Successful percutaneous retrieval of fractured umbilical artery catheter in a very low birth weight preterm neonate.

BACKGROUND

Umbilical arterial catheterisation is a common intervention performed in the neonatal intensive care unit (NICU) especially in extremely preterm and extremely low birth weight neonates. Rarely catheter fracture or breakage can occur, leaving behind part of the catheter in the aorta. A handful of cases have been reported in the literature, with the majority being managed surgically. There is no well-established protocol or consensus on the optimal management of such situations, leaving clinicians to rely on innovative and individualized approaches to address this critical situation.

CASE PRESENTATION

We report the successful percutaneous retrieval of a fractured umbilical artery catheter (UAC) from the aorta of a very low birth weight preterm neonate born at 28 weeks of gestation, who was undergoing treatment for neonatal sepsis at our hospital's NICU. The fractured catheter was retrieved via the right femoral artery using an improvised snare created by double-folding and inserting a 300 cm, 0.014-inch coronary guidewire into a Judkins Right (JR) 6F coronary guide catheter, forming a loop that protruded from its distal end. Following retrieval, the patient exhibited transiently weak pulses and decreased limb movement in the accessed limb. A duplex colour Doppler scan was performed which ruled out thrombosis or dissection. It was attributed to a spasm of the common femoral artery, which recovered eventually.

CONCLUSION

This case demonstrates the feasibility and effectiveness of successful percutaneous removal of the fractured UAC from the aorta in very low birth weight preterm neonates and underscores the importance of innovative use of improvising hardware, appropriating it to the small size of the patient.