Case 3: Broviac Catheter Placement in a Neonatal Intensive Care Unit

Abstract

A 43-day-old (1.3-kg) girl born at 27 weeks is scheduled for a Broviac catheter replacement in the neonatal intensive care unit (NICU). She is in the NICU because of respiratory failure, bronchopulmonary dysplasia, right lower lobe pneumonia, and sepsis. She has failed extubation twice in the past due to postextubation stridor and desaturation. The day before surgery, the patient was intubated with a 2.5 endotracheal tube (ETT) by the NICU staff and ventilated for 12 h before surgery. A large leak has been suspected around the endotracheal tube (ETT), as the nurse has noted hearing the patient cough and cry. At present, the ventilator is working and the settings include an FIO₂ of 30 %, respiratory rate of 14, and the pressure setting of 24/5. The patient’s vital signs include a respiratory rate of 60, heart rate of 150 bpm, and oxygen saturation by pulse oximetry of 92–95 %. Her gastric tube is in place and open to air. Coarse breath sounds are heard bilaterally without evidence of leakage around the ETT. Standard monitoring devices are placed except for an end-tidal CO₂ monitor, which is not available. A preoperative radiography of the chest had been taken earlier in the morning but is unavailable for viewing.