Cardiac tamponade in 4010g neonate

dawngloves, BSN, RN · Nov 23, 2002

Wow! I've never seen that and hope I never do!

I hope your son's outcome was postive. That must have been very hard.

NicuGal, MSN, RN · Nov 24, 2002

Wow...those apgars are low...did they give a reason why? Asphxia comes to mind...if there is damage to the heart muscle then you can develop a tamponade. But that is pretty rare in neonates. Did he have an infection of some sort that could lead to pericardititis?

Pulmonary HTN occurs when a baby is in trouble..ie asphyxia or sepsis.

Those are just my speculations.

PowercarveJen · Nov 24, 2002

They never told us about any infection. but that dosn't mean that it didn't happen. I know that they were not able to suction his airway after he was born because they had no bag or O2 and when they finally got min O2@ about 4min they didn't take the time to suction so they were worried about pneumonia. the fluid was"clear in color" so I don't know if that makes a difference either.

KRVRN, BSN, RN · Nov 24, 2002

Clear fluid does make a difference, mec stained fluid can lead to mec aspiration, which can lead to pulmonary HTN. Also, mec in the fluid would have indicated an in utero distress. But the presence of clear-fluid doesn't necessarily mean he wasn't stressed in utero.

No bag or O2 (if needed) would contribute to low apgars. Did they even sx with a bulb syringe? Why was O2 unavailable?

KRVRN, BSN, RN · Nov 24, 2002

Does he have a congenital heart defect of any sort? Were/are you diabetic?

PowercarveJen · Nov 24, 2002

I am not diabetic and he has no heart defect He had an umbilicacal IV ?

nell · Nov 24, 2002

First of all PowercarveJen, my sympathies for all you have been through. Secondly, how is your son doing now? I sincerely hope that even with all of that against him, he is OK...

I would really like to know why there was no bag/mask and suction available immediately.

Cardiac Tamponade is thankfully very rare and like just about everything in medicine, has numerous causes, not the least of which is umbilical catherterization. Catheter placement should always be confirmed by x-ray. Pericarditis and the cardiac trauma of chest compressions are also potential causes.

Pulmonary hypertension is more common and also has a number of precipitating factors such as asphyxia or meconium aspiration.

One could make a lot of suppositions about what happened in your son's case....

My thoughts are with you,

Nell

dawngloves, BSN, RN · Nov 26, 2002

I think Nell is onto something with the chest compressions.

NicuGal, MSN, RN · Nov 26, 2002

I think she said that the CPR was later and they found he had a tamponade, so if that is the case, then that isn't related. :confused: When did they put the UVC in...after the delivery? Usually for emergency purposes in the DR it is only inserted a short way. If it is for long term use, it would have been checked with a babygram. I've seen them coiled up in the heart, but none of them ever had a tamponade. Hmmmm...I'll have to let my cogs turn on this one a bit more.

Did they ever give you any explanations at all? I would really be doing some heavy question asking after all that. I hope your son is okay!

PowercarveJen · Nov 26, 2002

THe UVC(umbilical vein cath?)was put in as soon as he was transfered to the NICU from the delivery room. To make matters worse I lost~2000cc of blood and passed out.The next day(I was in a wheelchair as they were not letting me out of bed) they told us that he was doing very well (almost on room air)one min. and then the next min. he was not breathing/blue and they called the code, then the CPR for 35 min. Sometime during the course of the CPR the found the fluid. They never gave us any explanation for the whole scenario. But I am pleased to say that he is scoring 3-4 months ahead of his age in the cognitive and motor skills

karenelizabeth · Dec 4, 2002

I have seen this only once it was in a baby with an umbilical line. In this case it was clear that the cause of the cardiac tamponade was the long line as the fluid from it was milky white and obviously lipid that the baby had been recieving.

Although there are other causes of cardiac tamponade the way you talk of "fluid rather than "blood" or "puss" mades me wouder

I expect most units have similar policies on their insertion and care but here are ours. Umbilical (long) lines ideally sit in a large vein and preferably just outside the heart.

We use them in babies that are likely to need long term fluid therapy (particularly very preterm infants) as they last longer than ordinary canulas need fewer changes so cause less trauma to the baby. Initially they are inserted into the umbilicus because it is less traumatic for the baby, later into a vein in the leg or arm.

They have two major risks, infection is the most common and we are ultra careful changing fluids etc to try and prevent this. The 2nd is that they puncture the heart or pulmonary artery, we try to prevent this with the position (as I said just out side the heart not in it) and this is checked by an xray just after insertion to insure it's correct position. BUT sometimes they move the flow of blood seems to straighten the lines and very occasionally the tip flows into the heart this is quite rare I have worked in intensive care for 8 years and only seen it once.

I hope you and your little one are doing well now