Patent Ductus Arteriosis (PDA)

Diagnosis

and

Treatment

What is a Patent Ductus Arteriosus?

A PDA is present is all babies in utero to shunt the blood flow away from the lungs

When the infant is born, the ductus should close within 15 hours of life

When the ductus does not close, this is called a Patent Ductus Arteriosus (PDA)

Signs and Symptoms of PDA

Symptoms depend on the size of the ductus and how much blood flow it carries.

Increased blood flow can overload the lungs and make the heart pump harder.

Symptoms include: fast breathing, increased in the work of breathing, more frequent respiratory infections, tiring more easily, and/or poor growth.

If the PDA is small, it may cause no symptoms, but can be detected by evaluation of a heart murmur.

Diagnosis of a PDA

Characteristic heart murmur Chest X-ray shows enlarged heart and

evidence of an excessive amount of blood flow to the lungs.

Echocardiogram demonstrates the flow of blood through the patent ductus arteriosus.

Treatment of a PDA

In symptomatic newborns, time will be allowed for the ductus to close on it’s own as long as the heart failure can be easily managed.

If symptoms are severe, medical or surgical closure is needed.

Medical treatment: Indomethacin. This drug helps to constrict the muscle in the wall of the PDA to close it.

Indomethacin

Generally only two courses given More courses not recommended:

– Risk of head bleed and isolated perferation due to vasoconstriction

If not successful, ligation considered

PDA Ligation

If medical treatment does not work, a surgical repair must be performed.

The PDA is “tied off” during surgery and blood flow is returned to normal

PDA Ligation

PDA’s are repaired in the operating room or at the bedside in the unit.

The surgeon will decide where the surgery will be performed.

When the repair is scheduled for the unit, refer to the RCNIC policy book, section III-2.04.

Nursing ResponsibilitiesBefore and During PDA

Giraffe bed Screens IV access Blood on call Labs as ordered Code Drugs Sedation/pain medication Chest tube set up/extra suction Maintain sterile field Documentation

Possible Complications

Bleeding Pneumothorax Infection Hemodynamic Issues Fluid retention/respiratory Instability/electrolyte Reoccurrence/failure to thrive

Recovery

Wean from medications as tolerated Wean from vent Start feeds slowly and progress to bolus Activity as tolerated

Cincinnati Children’s Heart Center Encyclopedia

Provides information on cardiac diseases, defects and disorders.

Also provides information about diagnosis and treatment for different anomalies.

Available for families and staff. Access site at www.cincinnatichildrens.org. Search “cardiac”.