Medical question

peppy · 03-03-2009, 01:40 PM

I am looking for a source for medical procedural protocol.

Specifically umbilical catheter placement in neonates.

Is there a book or a source other than medical school? Are there any written rules or do you just go by feel?

TSNAPCRACKLEPOP · TSNAPCRACKLEPOP's Garage

many surgical procedures are now demonstrated/recorded online. any neonatal surg procedure book would have it.

why do you ask?

TSNAPCRACKLEPOP · TSNAPCRACKLEPOP's Garage

those become nonfunctional soon after birth

peppy · 03-03-2009, 01:57 PM

I am curious about how the procedure was done on my son. They started with one size catheter and when they met resistance they went with a smaller catheter in the same artery, instead of using the other artery.

I just want to know all I can about the procedure.

TSNAPCRACKLEPOP · TSNAPCRACKLEPOP's Garage

in umbilicus, the artery contains unoxygenated blood, and the vein has oxygenated blood, opposite of the rest of the circulatory system. they commonly, on neonates, have to improvise what works in all tubes. I worked with neonates of r10 years, those guys are the supersharpest of the sharp! see Guyton's Physiology for starters.

TSNAPCRACKLEPOP · TSNAPCRACKLEPOP's Garage

one size doesnt fit all. how old is the little bugger? pix? I love those little sock hats they put on em, makes em look like elves.....german elves!

Noah930 · Noah930's Garage

A medical textbook (for neonatal intensive care) might have the procedure listed. The manufacturer of the catheter may also have a set of instructions. That is probably not included in the catheter kit, itself. But it might be somewhere in the literature published by the manufacturer (and it may be available from one of their product reps or even, rarely, online).

FWIW, after a complication like the one you went through, the case should have been reviewed by the hospital. The service that performed the procedure may have a formal Morbidity and Mortality (M&M) conference. The case will have been presented and discussion would have taken place amongst the entire department. There may or may not also have been a separate investigation performed by the hospital's quality control department. From my personal experiences, at least, general surgeons have no problem ripping on each other in these types of scenarios. Don't know if that's the case in other departments. Often, though, those records aren't available to the public (or even you). I've seen patients' families get ahold of them, though I'm not sure how that was done (as, again, they're not supposed to have access to them).

Gogar · 03-03-2009, 02:19 PM

Quote:

Originally Posted by TSNAPCRACKLEPOP

one size doesnt fit all. how old is the little bugger? pix? I love those little sock hats they put on em, makes em look like elves.....german elves!

Aw geez.

peppy · 03-03-2009, 02:23 PM

Quote:

Originally Posted by TSNAPCRACKLEPOP

one size doesnt fit all. how old is the little bugger? pix? I love those little sock hats they put on em, makes em look like elves.....german elves!

Thanks for the book title.

From what I have read a child weighing 1760 grams should use a 5.

On my son the Dr. started out with a 5 and met resistance he then removed the catheter and used a 3.5.

If my questions sound like I am an idiot I apologize.

peppy · 03-03-2009, 02:27 PM

Quote:

Originally Posted by Noah930

A medical textbook (for neonatal intensive care) might have the procedure listed. The manufacturer of the catheter may also have a set of instructions. That is probably not included in the catheter kit, itself. But it might be somewhere in the literature published by the manufacturer (and it may be available from one of their product reps or even, rarely, online).

FWIW, after a complication like the one you went through, the case should have been reviewed by the hospital. The service that performed the procedure may have a formal Morbidity and Mortality (M&M) conference. The case will have been presented and discussion would have taken place amongst the entire department. There may or may not also have been a separate investigation performed by the hospital's quality control department. From my personal experiences, at least, general surgeons have no problem ripping on each other in these types of scenarios. Don't know if that's the case in other departments. Often, though, those records aren't available to the public (or even you). I've seen patients' families get ahold of them, though I'm not sure how that was done (as, again, they're not supposed to have access to them).

Thanks Noah930, I have never even talked to the doctor that did the procedure.

peppy · 03-03-2009, 04:29 PM

I found this on the web, I don't know how reliable it is.

http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/procedures/insertionumbilicalvessel.html

XIII. Grasping the catheter between the thumb and forefinger or with a forceps, the catheter can be inserted into the lumen of the dilated artery. Supporting the stump is usually necessary. Once the catheter has ben inserted, it may encounter resistance at the level of the anterior abdominal wall or at the bladder. This resistance can usually be overcome by application of gentle steady pressure. Repeated probing movements or excessive pressure must be avoided. If unsuccessful, wait 2-3 minutes until the vasospasm ceases, or attempt the other umbilical artery.

Moses · 03-03-2009, 04:34 PM

I think Markus (Livi) is your guy.

peppy · 03-03-2009, 04:38 PM

Quote:

Originally Posted by Moses

I think Markus (Livi) is your guy.

Thanks Moses.

I have already imposed on Markus enough.

peppy · 03-04-2009, 04:32 AM

Bump for more suggestions.

Thanks

peppy · 03-04-2009, 05:42 AM

Quote:

Originally Posted by TSNAPCRACKLEPOP

one size doesnt fit all. how old is the little bugger? pix? I love those little sock hats they put on em, makes em look like elves.....german elves!

We had twins, and these are two pics that show the progress.

livi · 03-04-2009, 06:12 AM

Quote:

Originally Posted by peppy

Thanks Moses.

I have already imposed on Markus enough.

Don´t worry about it, Peppy. This is about the only topic I can contribute with anything reasonably meaningful so I am only happy if I can help.

I believe you have e-mailed me before, right? Please do so again, if you think I can be of any help.

peppy · 03-04-2009, 06:55 AM

Thanks Markus, e-mail sent.

peppy · 03-04-2009, 02:56 PM

Once again Markus comes to the rescue.

This board is really blessed with some really great minds, and I get to tap into the wealth whenever I need.

THANKS!!

AFD660 · 03-04-2009, 03:58 PM

i'm an army medic....im not sure if i can be much help... i dont know much about newborns or neonates... but just a bit... we were told that the umbilical cord stump... can be used as a catheter site... we can also use the head as an iv site... anywhere else is to hard to find... the head has veins that are visible but if the stump is still there it has a bigger vein available for use... bigger is better in this case... LOL... hope this helps... but the docs know their job really well... espically the newborn docs since the patient cant tell where it hurts or let the doc know whats wrong with them... well take it easy man... congratulation on the kids...