Chapter 34 ■ Management of Vascular Spasm and Thrombosis 225

Topical application of 2% nitroglycerine ointment at a dose of 4 mm/kg body weight, applied as a

thin film over the affected areas; may be repeated

after 8 hours (9–11).

D. Management of Catheter-Related

Thromboembolism

1. General principles

a. Thrombolysis to restore catheter patency for

obstructed central venous catheters is described in

Chapter 32.

b. Management of vascular thrombosis may involve

one or more of the following: Supportive care with

continued close observation, anticoagulation,

thrombolytic therapy, or surgical intervention

(1,8,12,13).

c. Infant should be managed in an appropriately

staffed and equipped neonatal intensive care unit

where anticoagulant or thrombolytic therapy can be

administered and monitored closely and supportive

and surgical care are readily available. Consultation

with pediatric hematology is recommended. Plastic

or vascular surgical consultation may be required.

d. Treatment of catheter-related thrombosis in neonates is still evolving. Current published guidelines

for treatment are based on common clinical practice, case studies, and extrapolation of principles of

therapy from adult guidelines (12,13).

e. Supportive care: Correct volume depletion, electrolyte abnormalities, anemia, thrombocytopenia,

treatment of sepsis.

f. Treatment is highly individualized and is determined by the site and extent of thrombosis, and the

degree to which diminished perfusion to the

affected extremity or organ affects function, and

the potential risk of bleeding complications associated with anticoagulant or thrombolytic therapy

(8,12,13).

g. Expectant management or “watchful waiting”—

close monitoring without anticoagulation or thrombolysis may be appropriate for some infants (1,12).