Menu Search Donate
NICU guideline identifier

Cardiac - management of balloon atrial septostomy for congenital heart defects in NICU

This document is only valid for the day on which it is accessed. Please read our disclaimer.

The Paediatric Cardiology team from Starship Hospital will determine the need for a balloon atrial septostomy in neonates with congenital heart disease. A paediatric cardiology consultant or fellow will carry out the procedure in the NICU.

SMO/Registrar / NS-ANP to ensure

  1. Cardiologist has obtained written consent from parents.
  2. The Neonatologist on-call is informed and shall be present at the bedside.
  3. 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. A second PIV will be required to give other medications during the procedure.
  4. Infant is intubated and ventilated prior to procedure. Intubation shall be performed by senior registrar/fellow/NS-ANP or SMO.
  5. Fentanyl bolus (10 -20 micrograms/kg) is given prior to procedure; consider second bolus if procedure is more than 30 minutes.
  6. Muscle relaxant should be considered in discussion with the cardiologist. Use Rocuronium (1mg/kg) IV push.
  7. Skin disinfectant appropriate to gestation

Nursing responsibilities

  1. Blood gas, FBC, group & cross-match, and U&Es are taken as ordered. Coagulation profile is not routinely required unless bleeding tendencies are suspected.
  2. NBM >4 hours (breast milk or formula) and commence intravenous fluids as prescribed.
  3. The baby is nursed on a heat table.
  4. Fentanyl and Rocuronium (1mg/kg) should be prepared.
  5. Two nurses need to be in attendance to manage ventilation and drug administration throughout procedure.
  6. Ensure continuous monitoring including pre and post ductal saturations and blood pressure.
  7. Monitor sedation levels

Postoperative care

Usual care is to extubate as soon as respiratory status allows. Liaise with Cardiology team regarding PGE1 management.

  1. 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
  2. Keep saturations within acceptable limits (as per cardiology team). Report immediately any changes in baseline levels to registrar/NS-ANP/NP.
  3. Maintain ventilation as per orders.
  4. Discontinue sedation and aim to extubate as soon as clinically appropriate.
  5. Review prostin infusion (as per cardiology team).
  6. Observe for signs of bleeding from access sites (umbilical or femoral). Report excess bleeding. Apply pressure as required.
  7. Neurovascular observations of lower limbs. Inform registrar / NS-ANP of discolouration, coolness, and / or decreased pulses
  8. If umbilical lines are to be used post procedure, secure in situ. Confirm position with an X-ray prior to commencing fluids.
  9. Arterial / Capillary blood gas as ordered by registrar/ NS-ANP / cardiology team

Note: The infant should not be in pain once the catheter is removed. Ongoing sedation is not required unless for other purposes.

Potential Complications of a Balloon Atrial Septostomy

  1. Sinus bradycardia (transient - common at time of procedure, usually self-limiting)
  2. Bleeding from access sites
  3. Reduced perfusion to lower limbs
  4. Embolism of clot
  5. Cardiac tamponade (rare)

Did you find this information helpful?

Document Control

  • Date last published: 17 December 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology, Paediatric Cardiology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years