Nilüfer OKUR MATUR, Muhammet ASENA, Kıymet ÇELİK, Nurettin OKUR

Umblikal Kateter İlişkili Portal Ven Trombozu: Bir Merkez Deneyimi

Amaç: Yenidoğan yoğun bakım ünitelerinde giderek artan sıklıkta invaziv girişimler yapılmaktadır. Özellikle preterm bebeklere sıklıkla umblikal kateterler takılmaktadır. Bu çalışmanın amacı kliniğimizde takılan umblikalkateterlerin portal ventrombozu (PVT) ile ilişkisini ve risk faktörlerini belirleyebilmektir.Materyal ve metod: Retrospektif olarak 01 Ekim 2017-31 Aralık 2018 tarihleri arasında kliniğimiz yenidoğan yoğun bakım ünitesinde izlenen gestasyon yaşı 32 hafta ve altında olan, umblikal kateter takılan ve en az 6 saat boyunca kateter takılı olan preterm bebekler çalışmaya dahil edildi. Umblikal ven kateteri (UVK) takılan hastaların taburculuk öncesi PVT açısından yapılan portal venöz doppler ultrasonografi (USG) sonuçları ile perinatal risk faktörleri ve kateter ile ilgili özellikler değerlendirildi.Bulgular: 142 hastaya UVK takıldı. 118 hastanın doppler USG sonucuna ulaşıldı. On beş (%9,9) hastada doppler USG ile PVT saptandı. PVT saptanan hastaların hiçbirinde klinik bulgu yoktu. PVT saptanan hastaların ortalama gestasyon yaşı ve doğum ağırlığı, PVT saptanmayan hastalardan daha düşüktü. On dört hastada portal venin sol dalında tromboz saptanırken, bir hastada ana portal vende tromboz saptandı.Tromboz saptanan bir hastada annede gestasyonel diyabet mevcuttu. PVT saptanan hastaların geç neonatal sepsis ve bronkopulmoner displazi oranları daha yüksekti, hastanede yatış süresi daha uzundu. Yine bu grupta kateterin alçak yerleşim oranı daha fazla, kateter kalış süresi ise diğer gruba göre daha uzundu. Sonuç: Umblikal ven kateterizasyonu PVT gelişimi için önemli bir risk faktörüdür. UVK takılan, özellikle düşük doğum ağırlıklı hastalar PVT açısından portal doppler USG ile değerlendirilmelidir.

Anahtar Kelimeler:

portal ven, preterm

Umbilical Catheter-Associated Portal Vein Thrombosis: A Center Experience

Background: Invasive procedures are increasingly used in neonatal intensive care units. Umbilical catheters are frequently attached to preterm babies. The aim of this study is to determine the relationship and risk factors of umbilical catheters inserted in our clinic with portal vein thrombosis (PVT).Materials and Methods: We retrospectively evaluated preterm infants with a gestational age of 32 weeks and below, who had a umbilical vein catheter (UVC) inserted in our neonatal intensive care unit between 01 October 2017 and 31 December 2018, and who had a catheter inserted for at least 6 hours. UVC inserted cases were evaluated for portal venous doppler ultrasonograpy (USG) examination before discharge. Perinatal risk factors and properties related to catheter were evaluated.Results: A total of 142 patients underwent UVC insertion. Doppler USG results of 118 patients were achieved. In 15 (9.9%) cases, portal vein thrombosis was detected by doppler USG. None of the patients with PVT had clinical findings. The mean gestational age and birth weight were lower in patients with PVT. Thrombosis was detected in the left branch of portal vein in 14 patients and thrombosis in the main portal vein in one patient. In a patient with PVT, gestational diabetes was present in the mother. Patients with PVT had higher rates of late neonatal sepsis and bronchopulmonary dysplasia, and the length of hospitalization was longer. In this group, the low placement rate of the catheter was higher, and the length of catheter stay was longer than other group. Conclusions: Umbilical vein catheterization is an important risk factor for the development of PVT. Especially low birth weight infants with UVC should be evaluated with portal doppler USG for PVT.

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