Management of Balloon Atrial Septostomy for Congenital Heart Defects in the NICU
Approved by Clinical Practice Committee in collaboration with John Wright & Julie Stubbs (Cardiology)
|Registrar Responsibilities||Nursing Responsibilities||Postoperative Care|
Cardiologist has obtained written consent from parents.
The Neonatologist on-call is informed and shall attend
Alternative IV access is present for the prostaglandin infusion if the infant is receiving this via an umbilical line and this route is likely to be used for catheterisation
Infant is intubated and ventilated prior to procedure
Fentanyl bolus (10 -20 micrograms/kg) is given prior to procedure; consider second bolus or Fentanyl infusion (1-5 micrograms/kg/hour) if procedure is more than 30 minutes
Skin disinfectant appropriate to gestation
Blood gas, FBC, group & cross-match, and U&Es are taken as ordered. Coagulation profile is not routinely required unless bleeding tendencies are suspected
NBM >4 hours (breast milk) or >6 hrs (formula) and commence intra venous fluids as prescribed
The baby is nursed on a heat table
Fentanyl and Pancuronium should be prepared
Two nurses need to be in attendance to manage ventilation and drug administration throughout procedure
Ensure continuous monitoring including pre and post ductal saturations
Monitor sedation levels
Ensure continuous monitoring is maintained
and observations recorded half hourly for the first 2 hours, then hourly of:
• Cardio-respiratory status
• Blood pressure
• Saturations (pre and post ductal)
• Skin temperature
Keep saturations within acceptable limits (as per cardiology team). Report immediately any changes in baseline levels to registrar/NS-ANP
Maintain ventilation as per orders.
Aim to discontinue sedation and extubate if clinically appropriate.
Review prostin infusion (as per cardiology team).
Observe for signs of bleeding from access sites (umbilical or femoral). Report excess bleeding. Apply pressure as required.
Neurovascular observations of lower limbs. Inform registrar / NS-ANP of discolouration, coolness, and / or decreased pulses
If umbilical lines are to be used post procedure,
secure in situ.
Confirm position with an X-ray prior to commencing fluids.
Arterial / Capillary blood gas as ordered by registrar/ NS-ANP / cardiology team
Ensure adequate analgesia
Note: The infant should not be in pain
once the catheter is removed. Ongoing sedation is not required unless for other
Sinus bradycardia (transient – common at time of procedure, usually self limiting)
Bleeding from access sites
Reduced perfusion to lower limbs
Embolism of clot
Cardiac tamponade (rare)