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Peripherally Inserted Central Catheters Complicated by Vascular Erosion in Neonates
Brian P Blackwood1, Kathryn N Farrow2, Stan Kim2
1Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA.
JPEN. Journal of Parenteral and Enteral Nutrition
|February 21, 2015
Summary
Peripherally inserted central catheters (PICCs) can cause rare but serious vascular erosions in pediatric patients. Optimal catheter tip placement near the atrial-caval junction is crucial for preventing this complication.
Area of Science:
- Pediatric critical care medicine
- Vascular access devices
- Medical device complications
Background:
- Peripherally inserted central catheters (PICCs) are essential for venous access in neonates and children.
- While generally safe, PICCs can lead to severe complications including infections, thrombosis, and extravasation.
- Vascular erosion into the pleural space is a rare but significant complication of PICCs.
Observation:
- This study reviewed 4 cases of PICC-related vascular erosions into the pleural space over two years.
- The cases involved both small and silicone-based catheters.
- Literature on this specific complication is limited.
Findings:
- Optimal PICC tip placement, ideally at the atrial-caval junction, is critical for minimizing perforation risk.
- The vena cava's thicker wall near the atrium may reduce perforation likelihood.
- Hyperosmolar fluid dilution, facilitated by this position, might also mitigate erosion risk.
Implications:
- Proper PICC tip placement and confirmation are paramount for patient safety.
- Routine daily chest X-rays for upper extremity PICCs with parenteral nutrition are not recommended due to radiation concerns.
- A low threshold for chest X-ray in patients with respiratory symptoms is advised to detect potential vascular erosion early.
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