Neonatal Procedures and Calculations

Question 1

Optimal position for tip of catheter for upper and lower extremity PICCs on X-ray?

Answer 1

Scalp and upper-extremity PICCs: T3-T5 (~RA-SVC junction)

Lower extremity PICCs: T8-T10 (~RA-IVC junction)

Question 2

Anatomy of upper extremity veins leading to the SVC?

Answer 2

From the antecubital fossa:

Cephalic vein (superior) and basilic vein (inferior) merge together to form the axillary vein > subclavian vein > drains into the brachiocephalic vein > superior VC > RA

Question 3

Cephalic vein PICC: effect of abducted vs adducted UE on catheter position?

Answer 3

Abduction at shoulder joint: migrates catheter inwards

Adduction at shoulder joint: retracts catheter, moves tip outward

Question 4

Basilic vein PICC: effect of abducted vs adducted UE on catheter position?

Answer 4

Abduction at shoulder joint: retracts catheter, moves tip outward

Adduction at shoulder joint: migrates catheter inwards

Question 5

What is an endoscopic third ventriculostomy?

Answer 5

Indicated for certain cases of hydrocephalus (not post-infectious or post-hemorrhagic?); make a hole through the floor of the third ventricle to offload CSF pressure within the brain, CSF will flow into the basilar cisterns or space surrounding the spinal cord

+/- choroid plexus ablation to prevent excess CSF production

Question 6

Management of a myelomeningocele

Answer 6

Cover exposed area with moist sterile dressing/plastic wrap before surgical repair (needs to be performed within the first 48 hours)

Question 7

What are different forms of heat loss in the immediate post-natal period?

Answer 7

Evaporative- Loss of heat with evaporation of body water (preventative NeoWrap and isolette humidity in ELBW infants)

Conduction- Loss of heat upon contact with a cooler surface

Convective- Loss of heat during passing air currents

Radiant- Loss of radiating heat due to a surrounding cooler environment