///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Vascular access in the high-risk parturient

Abstract Number: 39
Abstract Type: Case Report/Case Series

Bridget M Marroquin MD1 ; Kathleen A Smith MD2; Fred J Spielman MD3

Peripartum hemorrhage remains the leading cause of maternal mortality. Placental abnormalities, specifically placenta accreta and its variants, are responsible for life threatening blood loss. Adequate preparation when anticipating significant bleeding is crucial.

The ability to have immediate and adequate vascular access (VA) is of paramount importance when caring for patients with placenta accreta. Patients may spend weeks in the hospital often beginning with viability of their fetus. Sufficient peripheral VA often becomes problematic. Intravenous catheter patency is short lived due to infiltration of the veins or blood clot. Blood sampling for laboratory studies traumatize other potential VA sites.

We describe a novel method of maintaining adequate long-term VA for parturients at risk for massive hemorrhage. We employed this technique in two patients.

43-year old G4 P0030 admitted at 24 weeks EGA with placenta previa, placenta increta, and significant bleeding history. She required eight units of red blood cells after hemorrhage earlier in gestation. She had documented difficult VA during other hospitalizations and adequate peripheral IV access was unsuccessful at admission.

27-year-old G7 P3033 admitted at 23 weeks EGA with complete placenta previa and placenta percreta involving the bladder. As hospitalization progressed, adequate VA proved difficult.

Large-caliber, 14 french, double lumen central venous catheters were placed in these patients by our hospitals interventional radiology team. The catheters were placed using ultrasound guidance and minimal flouroscopy. These catheters are sometimes referred to as "vascaths" and are often used for hemodialyis or pheresis.

Vascaths are longer lasting compared to other central lines. Another advantage is that the caliber of a vascath is larger compared to peripherally inserted central catheter (PICC line) or the central venous catheters commonly placed by anesthesiologists. Some disadvantages are that placement requires an invasive procedure away from the antepartum unit. Fluoroscopy is employed although with ultrasound technology, fluoroscopy exposure is limited. Infection rate is equivalent to other internal jugular access lines.

The catheters were well tolerated by the patients without complications. We feel strongly that in selected patients the placement of a vascath can be life saving.

SOAP 2009