Critically ill infant survives in Ctg after ultrasound-guided central line placement

A five-month-old infant in Chattogram has survived severe sepsis and shock after doctors successfully inserted a central venous line using four-dimensional ultrasound, allowing emergency treatment to begin quickly.

The infant, Arham Khalid, developed severe sepsis after bronchopneumonia spread to his bloodstream, causing severe breathing difficulty and shock. At one point, doctors could no longer detect his pulse or blood pressure.

Arham was initially taken to Chattogram Maa-O-Shishu Hospital, where his condition deteriorated due to breathing difficulty, low oxygen levels and a spreading infection.

As conventional intravenous access could not be established, he was transferred to another hospital for paediatric intensive care.

Doctors then inserted a catheter into his jugular vein under ultrasound guidance on their first attempt. He is currently receiving treatment at a private hospital's paediatric intensive care unit (PICU). His father is Arif Hossain.

Dr Md Mohiuddin Mazed Chowdhury, an ICU specialist and assistant professor at Chattogram Medical College Hospital, told TBS that the infection had entered the child's bloodstream, causing severe sepsis and shock.

"Because conventional intravenous access could not be established, a central line was urgently inserted using ultrasound guidance," he said.

Using four-dimensional ultrasound, doctors were able to directly identify the blood vessel and insert the catheter on the first attempt, he said. The procedure provided immediate venous access for antibiotics, saline, injections and other emergency medicines.

Dr Mohiuddin said he had previously performed the procedure on more than 50 children at Dhaka Medical College Hospital, Chattogram Medical College Hospital, Parkview Hospital, Evercare Hospital and Labaid.

He said the procedure is more difficult in small children because their necks are shorter and there is limited space around blood vessels.

"With ultrasound guidance, the blood vessel can be seen directly, improving the accuracy of catheter placement," he said.

Dr Mohiuddin said the "golden hour" is particularly important in severe sepsis, as antibiotics and other emergency treatment need to begin within the first hour.

"If intravenous access cannot be established, these medicines cannot be administered quickly, increasing the risk for a critically ill child," he said.

He said only one doctor in the government sector and one in the private sector currently provide the service in Chattogram. A major institution such as Chattogram Medical College should have at least 10 doctors trained in the procedure, he added.

With support from the government and private sectors, more doctors could be trained, expanding access to rapid intravenous treatment for critically ill children and allowing emergency medicines to be administered without delay, he said.