DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
VASCULAR SPASM
- Blanching or cyanosis of extremity following insertion or manipulation of peripheral or umbilical arterial catheter (UAC)
- Remove catheter unless absolutely essential
- Elicit reflex vasodilation
- reflex vasospasm on insertion of UAC can occasionally be corrected by reflex vasodilation by warming
contralateral limb
- reflex vasospasm on insertion of UAC can occasionally be corrected by reflex vasodilation by warming
- Volume expansion
- if appropriate, give sodium chloride 0.9% 10 mL/kg as volume expander
- GTN patch
- use can be considered to improve perfusion but not trialled or licensed for use in babies. Discuss with
consultant
- use can be considered to improve perfusion but not trialled or licensed for use in babies. Discuss with
- Liaise with plastic surgeons, haematologists and other specialists as needed
VASCULAR THROMBOSIS
Clinical features suggesting vascular thrombosis
Site:
Clinical signs
- Pallor
- Cold arm/foot
- Weak or absent peripheral pulse
- Discolouration
- Gangrene
- Difficulty establishing a proper pulse oximetry trace
- Delayed capillary refill time on affected limb
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Systemic hypertension
- Haematuria
- Oliguria
- Renal failure
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Flank mass
- Haematuria
- Hypertension
- Thrombocytopenia
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Cool lower limbs
- Cyanosis
- Oedema
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Swelling of the upper limbs and head
- Chylothorax
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- High pressures on long line
- SVC obstruction
- Chylothorax
- Swelling
- Discolouration of extremity
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Heart failure
- Embolic phenomenon
Diagnostic imaging
- Echo
Clinical signs
- Respiratory failure
Diagnostic imaging
- Lung perfusion scan (at specialised centre)
MANAGEMENT OF THROMBOEMBOLISM
- Controversial
- Inadequate controlled trials
- Inform consultant
- Liaise with plastic surgeons, haematologists and other specialists as required
Treatment options
Conservative
- Observe closely with no intervention e.g. unilateral renal vein thrombosis
Anticoagulation and thrombolysis
- No controlled neonatal trials
- Use only under guidance from haematologist and/or plastic surgeon