1. Patent Ductus Arteriosis (PDA)
Diagnosis
and
Treatment

3. 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)
4th most common lesion
Incidence inversely related to gestational age
Apparent in 80% of infants weighing less than 1200gms at birth
3 times more common in females than males

4. 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.
Presents at 4-7 days with inability to wean from vent or has increased need for vent and O2 support
Bounding peripheral pulses
Widening pulse pressures(> 20mm Hg)

5. 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.
Continuous murmur may be present at upper left sternal border

6. 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.
PDA may prolong vent use beyond what may have been for initial lung disease
Conservative measures:
Fluid restriction
Diuretics

7. 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
Dosage is 0.1 to 0.2mg/kg/dose q8h for a total of 3 doses

8. 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

9. 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.

10. Nursing Responsibilities Before 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

11. Possible Complications
Bleeding
Pneumothorax
Infection
Hemodynamic Issues
Fluid retention/respiratory
Instability/electrolyte
Reoccurrence/failure to thrive

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

13. 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
Search “cardiac”.