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An unusual case presentation: pericardial tamponade complicating central venous catheter
M Garg1, C C Chang, R J Merritt
1Division of Neonatology/Pediatric Pulmonology, Childrens Hospital Los Angeles, CA 90027.
Insights
Peripherally inserted central venous catheters in premature infants can cause fatal heart perforation. Careful catheter placement is crucial to avoid this rare but deadly complication in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Medical Device Safety
Background:
- Central venous catheters are essential for nutritional support in very low birthweight infants.
- Surgically placed Broviac catheters have known infectious and mechanical risks.
- Silastic central venous catheters inserted peripherally are increasingly used due to a reported low complication rate.
Observation:
- A case of a very low birthweight infant with a peripherally inserted silastic central venous catheter is presented.
- The catheter perforated the right atrial appendage, leading to fatal pericardial tamponade.
- This represents a rare but nearly universally fatal complication.
Findings:
- Peripherally inserted silastic central venous catheters can lead to cardiac perforation.
- Right atrial appendage perforation by the catheter tip can cause pericardial tamponade.
- The complication is potentially avoidable with precise catheter tip placement.
Implications:
- Careful placement and confirmation of central venous catheter tip position are critical in neonates.
- Avoiding impingement on the heart wall is key to preventing perforation.
- Serial venograms may be a useful tool for verifying catheter position and preventing fatal outcomes.
Abstract:
The use of central venous catheters in very low birthweight infants to provide adequate calories for growth is an integral part of the care of the high-risk neonate. The use of surgically placed Broviac catheters has been associated with infectious and mechanical complications. Recently, there has been increasing use of silastic central venous catheters inserted through a peripheral vein and advanced to the right atrium. These catheters have a reported low rate of complications. However, we report a case of a very low birthweight infant in whom a peripherally inserted silastic catheter perforated the wall of the right atrial appendage and led to fatal pericardial tamponade. This is a very rare but nearly always fatal complication. It is potentially avoidable by careful placement of the tip of the central venous catheter, so that it is not impinging on a wall of the heart. Serial venograms may be useful to reconfirm the position of the catheter.