Friday, February 26, 2010

Neuro III

You are a pediatrician who is sued by the family of a premature infant who has lateralizing neurologic deficits. This infant was delivered at 30 weeks gestation and had poor Apgar scores. Due to a need for fluid resuscitation and an arterial blood gas, you performed a procedure. The post-procedural X-ray is shown above. Currently, the infant is 2 months old and he is not spontaneously moving his left side. The lawsuit states that you failed to flush the lines before inserting them.

Challenge: What happened?

Related Questions:
1. What procedure was done?

Image is shown under Fair Use.

1 comment:

Craig Chen said...

Neuro III

The X-ray shows the normal appearance of an umbilical artery catheter (single black arrow to white arrowhead to large arrowheads) and umbilical vein catheter (small arrowhead to double black arrows). The umbilical artery catheter enters the umbilicus, travels to the iliac artery and aorta. The umbilical vein catheter enters the umbilicus, travels in the umbilical vein, portal vein, ductus venosus, inferior vena cava, and right atrium. Neonates often have a patent foramen ovale. If the lines are not flushed prior to insertion, then an air embolus can be inserted into the umbilical vein, travel to the right atrium, cross over to the left atrium via the PFO, and lead to a cryptogenic stroke.

Sources: www.ajronline.org; bedside teaching by a pediatric intensivist.