Andrea was caring for a 33-week-old preterm infant suffering from severe hypoglycemia. The patient had been receiving D10W boluses through an IV in the left foot, but the IV infiltrated, raising concerns about potential tissue necrosis due to worsening glucose levels. In response, the physician placed an umbilical venous catheter (UVC) to provide more secure vascular access.

Shortly after the UVC was placed, several nurses began examining the patient's foot. Andrea noticed the infant becoming increasingly fussy and crying more than usual. Upon closer observation, she realized the UVC site had started bleeding heavily. She promptly alerted the nurses in the NICU, who quickly applied pressure to the site but recognized the need for additional assistance. The physician arrived to remove the UVC and secure the site, but the pressure applied by the nurse made it difficult for the doctor to visualize the area. Acting swiftly, Andrea grabbed the umbilical ties and applied firm pressure, helping control the bleeding and allowing the physician to properly secure the site.

After stabilizing the patient, Andrea reflected on an earlier incident during her shift. When her nurse had gone to check the infant’s blood glucose levels, she noticed the site from a previous heel prick, performed during the night shift, was still actively bleeding. Concerned, she immediately informed the patient’s nurse and questioned whether the infant might have an underlying bleeding disorder. The patient’s nurse contacted the parents, and the mother revealed that a close relative, an aunt, had a history of a bleeding disorder.

This new information prompted the team to insert a PICC line to safely administer D10W, draw blood samples, and conduct coagulation studies. These tests were critical in determining whether the infant shared the same bleeding condition, ensuring appropriate care moving forward.