Fatal cardiac tamponade in a neonate with a polyurethane central venous catheter

Fatal cardiac tamponade in a neonate receiving total parenteral nutrition via a polyurethane central venous catheter is presented. The literature is reviewed and the implications for management discussed. Correspondence to: G. Nicholls     

Cardiac tamponade and pericardial effusion due to venous umbilical catheterization

AIM: We present three cases of neonatal cardiac tamponade due to umbilical venous catheterization, a rare, but potentially fatal complication. METHODS: Timely diagnosis was made by echocardiography, and an urgent pericardiocentesis revealed TPN fluid. Perforation of the cardial wall was proven by contrast X-ray showing contrast diffusing into the pericardial space. DISCUSSION: Most frequently, perforation has a delayed course and results from endothelial injury, caused by the hyperosmolar fluids, leading to transmural necrosis and thrombosis. Subsequently, the fluid diffuses transmurally across the myocardium into the pericardium. As migration of the catheter tip can occur, we suggest that its position should be checked immediately after insertion and twice a week thereafter. CONCLUSION: Pericardial effusion and cardiac tamponade should be considered in any infant with a central venous line who develops a rapid, unexplained clinical deterioration. Timely diagnosis and drainage has been proven to be life-saving.     

Performance of percutaneous Silastic central venous feeding catheters in surgical neonates

In surgical neonates receiving total parenteral nutrition a prospective study was undertaken to assess the performance of fine-bore central venous Silastic catheters inserted percutaneously via a peripheral vein. During a 1-year period a total of 33 catheters was inserted into 28 neonates. The mean duration of catheter survival was 14.98.0 (range 4–34) days. No complications occurred with 22/33 (66%) catheters which were removed when redundant. Although there were no long-term sequelae, 11 (33%) catheters was removed because of complications, the commonest being sepsis, which occurred in 5 (15%) patients. No septic complications were detected in the 13 patients having a catheter for 10 days or less. Catheters positioned in the great veins peripheral to the superior vena cava and right atrium proved to be safe and reliable in the short term. Offprint requests to: M. D. Stringer     

Percutaneous transvenous extraction of a severed central venous catheter in the right atrium of a neonate

A case of nonsurgical removal of a severed central venous catheter that was located in the right atrium by the percutaneous transfemoral loop method in a newborn is reported. Many percutaneous techniques have been described for nonsurgical removal of intravascular or intracardiac foreign bodies in adults with good success rates; we believe this is the first report in an 11-day-old neonate. Offprint requests to: Soon-Ok Choi     

Percutaneous central venous catheter use in the very low birth weight neonate

A retrospective study was carried out comparing 61 very low birth weight infants (VLBW) with percutaneous central venous catheters with 92 infants managed with peripheral cannulae. Eighteen infants developed one or more episodes of catheter-associated bacteraemia. In 70% of cases the infection was successfully treated with the line in situ. Logistic regression analysis was performed to examine risk factors for bacteraemia. The duration of intravenous fluids and of intermittent positive pressure ventilation were both significant risks for infection (odds ratios and 95% confidence limits 4.4, 2.7–12.0 and 2.5, 1.0–6.1 respectively), but the presence of a silastic catheter was not an independent risk factor (odds ratio 0.6, 95% confidence limits 0.1–3.0).     

Neonatal hydrothorax following migration of a central venous catheter

The use of a central venous catheter may occasionally be associated with complications like sepsis, effusions and thrombosis. Migration of the central catheter is an unusual complication that often goes unrecognized. This case report is of a neonate who developed hydrothorax resulting from a migrating central line and highlights the need for a high level of clinical suspicion in diagnosing catheter related problems.     

Malfunctioning central venous catheters in children: a diagnostic approach

Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or ‘linogram’ technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications.     

中心静脉置管导致早产儿心包积液的临床分析

目的 探讨早产儿中心静脉置管导致心包积液的临床特征.方法 回顾性选择发生中心静脉置管相关心包积液的11例早产儿为研究对象,分析其置管特征、表现、治疗及预后.结果 中心静脉置管相关心包积液发生率为0.42％(11/2599).11例心包积液患儿的平均胎龄(30.1±2.6)周,平均出生体重(1240±234)g.心包积液...     

中心静脉导管持续胸腔闭式引流在儿童结核性胸膜炎中的应用

目的：探讨中心静脉导管持续胸腔闭式引流替代反复多次胸腔穿刺抽液治疗儿童结核性胸膜炎的效果。方法：在常规抗结核化疗的基础上,观察组（39例）患儿采取中心静脉导管持续胸腔闭式引流治疗,对照组（42例）采用反复多次胸腔穿刺抽液治疗,观察并比较两组患儿胸腔积液吸收时间、胸膜肥厚情况、住院时间、穿刺相关费用等。结果：中心静脉导管持续胸腔闭式引流组和反复多次胸腔穿刺抽液组相比,胸腔积液吸收加快（8±4 d vs 12±6 d,P<0.01),胸膜肥厚情况改善更好（1.50±0.25 mm vs 3.10±0.30 mm,P＜0.05),住院时间缩短 (11±3 d vs 18±6 d,P<0.01),穿刺相关费用降低（269±24元 vs 475±50元,P<0.05),患儿痛苦减轻。结论：中心静脉导管持续胸腔闭式引流治疗儿童结核性胸膜炎较反复多次胸腔穿刺抽液优势明显,适合在儿科临床中推广应用。     

Perforation complications of percutaneous central venous catheters in very low birthweight infants

OBJECTIVE: To prospectively survey perforation complications of consecutively inserted percutaneous central venous catheters (PCVC) in very low birthweight (VLBW) infants over a 2 year period. METHODOLOGY AND RESULTS: Three serious perforation complications were encountered in a series of 100 consecutive PCVC. One infant (birthweight 685 g) developed pericardial effusion and fatal cardiac tamponade during the use of a polyurethane PCVC. At autopsy, the pericardial sac contained 8 mL fluid with a glucose concentration of 109 mmol/L and the catheter tip was embedded in the right ventricular wall. The second infant (birthweight 1380 g) showed pleural effusion and transient immobility of the right diaphragmatic leaf after perforation of a similar PCVC into the right pleural cavity. The third perforation, causing subcutaneous oedema, occurred in a 655 g infant who had a silastic PCVC. CONCLUSIONS: The data suggest a 3% incidence for PCVC-associated symptomatic perforation complications and a 1% incidence for fatal perforations, despite a policy of careful placement. The data also indicate that perforation complications occur regardless of the size or material of the PCVC. Proper visualization of the PCVC and vigilant attention to its location is required to prevent these rare but potentially fatal complications.     

Peripherally inserted central venous catheter-related thrombosis in a neonate北大核心CSCD

患儿女,生后4 h,因早产、生后呼吸困难4 h入院。患儿生后第3天行经外周静脉穿刺的中心静脉导管(peripherally inserted central venous catheter,PICC)置管。生后第42天心脏彩超示下腔静脉右心房入口处血栓,考虑PICC置管相关血栓形成。予以低分子肝素抗凝、尿激酶溶栓等治疗。治疗2周后心脏彩超提示血栓缩小。病程中未出现出血、肺动脉栓塞等并发症。患儿好转出院。该文主要介绍新生儿PICC置管相关血栓的多学科诊疗。     

Cardiomegaly in a premature neonate after venous umbilical catheterization

Umbilical venous catheters allow rapid central access in neonates, but may be associated with various complications. We present a case of a newborn with pericardial effusion following umbilical venous catheterization. An extremely low birth weight infant was intubated for respiratory distress syndrome and had umbilical venous and arterial lines in place. Massive cardiomegaly was noted on the subsequent chest X-ray. Echocardiography revealed a large pericardial effusion without signs of tamponade. After removing the catheter, the effusion gradually resolved. While pericardial effusion is a well-known complication of percutaneous long central lines, only a few case reports have documented sudden cardiovascular compromise associated with umbilical venous catheters. Pericardial effusion may be asymptomatic and should be suspected in infants with central catheters and progressive cardiomegaly. The prompt removal of catheters and, if signs of cardiac tamponade are present, emergency pericardiocentesis may prove to be life-saving.     

Difficulty in removing a percutaneous central venous catheter inserted from a peripheral vein

Two girls with acute lymphocytic leukemia (ALL) are reported. There were difficulties in removing their central venous catheters inserted from a peripheral vein. One girl required surgery under general anesthesia for the removal. The other patient received continuous infusion of low dose urokinase from a distal peripheral vein. The residual catheter was then removed successfully.     

新生儿中心静脉导管相关性感染的预防

中心静脉导管是新生儿重症监护室常用的静脉通道,而感染是中心静脉导管置管术严重的并发症,各国的新生儿中心都在积极研究各种预防措施,但其有效性仍有争议.研究表明,严格无菌操作、洗必泰皮肤消毒剂、周期性更换辅料及导管连接装置、限期拔管、感染后及时拔管、抗生素封闭导管等措施在降低感染率方面有一定的作用.     

Pericardial effusion after pediatric hematopoietic cell transplant

PE can occur following HCT. However, the incidence, etiology, risk factors, and treatment remain unclear. We performed a retrospective study evaluating 355 pediatric recipients of HCT treated at a single institution between January 2005 and August 2010. No cases of PE were identified in the autologous HCT (auto‐HCT) recipients (0/43), while 19% (57/296) of allogeneic HCT (allo‐HCT) developed PE. Among the 57 PE patients, 40 (70%) were males; the median age at transplantation was 6.6 yr (0.1–17.3 yr). Thirty‐six patients (63%) had significant PE with 23 patients (40%) treated by pericardiocentesis, and 19 (33%) experiencing recurrent PE. OS rates for patients who developed PE were 84% at 100 days and 65% at three yr after HCT. Risk factors associated with PE on multivariate analysis included myeloablative conditioning (p = 0.01), delayed neutrophil engraftment (p < 0.01), and CMV + serostatus of the recipient (p = 0.03). Recipients with non‐malignant diseases were significantly less likely to die after development of PE (p = 0.02 and 0.004 when comparing with standard and high‐risk diseases, respectively). In summary, PE is a common and significant complication of pediatric allo‐HCT. Prospective studies are needed to better determine the etiology and optimal method of PE treatment after HCT.     

Unusual complications of central venous catheters in two infants with congenital venous anomalies associated with congenital heart disease

We report two infants with congenital heart disease who had unusual complications of indwelling central venous catheters related to anomalies of systemic and pulmonary venous drainage. Correspondence to: B. J. Pettitt     

Transient myeloproliferative disorder and eosinophilic pericardial effusion in a down syndrome neonate

Transient myeloproliferative disorder seen in neonates with Down syndrome is often thought to have a benign course. The authors describe the clinical and laboratory profile of a neonate with Down phenotype and transient myeloproliferative disorder with pericardial effusion as co-morbidity. Pericardial fluid analysis showed eosinophils. Pericardial effusion resolved with prednisolone therapy. Regression in hepatosplenomegaly with clearance of blasts was seen by third week of illness. The clinical course suggested a benign infiltration of the pericardium. Presence of eosinophils supports the differentiating capability of the blast cells in transient myeloproliferative disorders.     

Is central venous access in childhood osteomyelitis associated with increased morbidity?

Children with osteomyelitis need treatment with intravenous antibiotics for protracted periods. An implanted central venous line (CVL) is a good method to deliver this treatment. Between 1992 and 1996, 17 patients with osteomyelitis had 20 surgically inserted Hickmann-type CVLs. The outcome of these lines was studied. Patients ranged from 1 month to 14 years of age and the duration of use of the CVL ranged from 6 to 180 days. One CVL was removed because of line sepsis and 1 was removed because of exit-site infection. We conclude that surgically inserted Hickmann-type CVLs in children with a pre-existing focus of infection in the form of osteomyelitis did not result in increased morbidity in terms of line sepsis, and served the purpose of prolonged administration of antibiotics very well. Accepted: 10 March 1998     

A new technique for transumbilical insertion of central venous silicone catheters in newborn infants

AIM: A new technique allowing placement of umbilical silicone venous catheters (USVC) is described and compared with percutaneous silicone venous catheters (PSVC). METHODS: Data were retrospectively recorded for 198 infants with USVC and 141 infants with PSVC. RESULTS: Overall rate of complications was low and comparable in both groups: thrombosis 1.2%, catheter-related sepsis 3.5% and mechanical obstruction 5%. CONCLUSION: A new device allows safe introduction of silicone catheters into the umbilical vein.