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Published on: June 12, 2021
Cardiac Tamponade Due to Pericardial Effusion Following Peripherally Inserted Central Catheter: A Single-Institution
Ha T Trinh1, Thien T Nguyen1, Tinh T Nguyen2,1,3
1Neonatal Intensive Care Unit, Children's Hospital 2, Ho Chi Minh City, VNM.
Insights
Misplaced peripherally inserted central catheters (PICCs) in neonates can cause cardiac tamponade. Cardiac point-of-care ultrasound (POCUS) is crucial for timely diagnosis and management, preventing fatal outcomes.
Area of Science:
- Neonatal intensive care
- Cardiology
- Medical devices
Background:
- Peripherally inserted central catheters (PICCs) offer benefits but carry risks.
- Misplacement of PICCs can lead to life-threatening complications like pericardial effusion (PCE) and cardiac tamponade (CT).
Observation:
- A retrospective analysis of four neonates in a NICU who developed CT due to misplaced PICCs.
- Cases involved preterm infants (28-30 weeks gestation, 900-1500g) with CT developing 3-24 days post-PICC insertion.
- Clinical signs included hemodynamic instability, lethargy, apnea, bradycardia, and cardiovascular collapse.
Findings:
- Cardiac point-of-care ultrasound (POCUS) was used to diagnose PCE/CT and guide pericardiocentesis.
- Aspirated fluid analysis indicated parenteral nutrition components.
- All four cases were successfully managed without mortality.
Implications:
- POCUS is vital for prompt identification of PCE/CT in neonates with sudden deterioration post-PICC insertion.
- Timely diagnosis, pericardiocentesis, and PICC malposition prevention are critical.
- Routine PICC position monitoring and considering POCUS over X-ray for tip confirmation are recommended.
Introduction:
Although the use of peripherally inserted central catheters (PICCs) has many advantages, misplacement can lead to serious life-threatening complications such as pericardial effusion (PCE) and cardiac tamponade (CT). This report aims to describe four cases of CT resulting from misplaced PICC, which were successfully managed.
Methods:
Retrospective analysis of neonates who required PICC insertion and had PCE leading to CT in the Neonatal Intensive Care Unit (NICU) at The Children's Hospital 2, Ho Chi Minh City, Vietnam, during the year 2022.
Results:
Four cases involved preterm infants at 28-30 weeks gestational age, weighing between 900-1,500 grams. The PCE/CT developed between 3 and 24 days following PICC insertion. The abrupt onset with clinical manifestations that showed hemodynamic instability included sudden deterioration, lethargy, apnea, bradycardia, pale skin, and cardiovascular collapse. We use cardiac point of care ultrasound (POCUS) to assess the condition of these patients and guide the pericardiocentesis procedure. The analysis of the aspirated fluid used for PCE/CT treatment is consistent with the component of parenteral nutrition. No deaths were encountered.
Conclusion:
Neonates presenting sudden deterioration following PICC insertion should undergo POCUS to prompt identifying PCE/CT. Timely diagnosis via POCUS, prompt pericardiocentesis, and prevention of misplaced PICC-associated serious complications are crucial. Monitoring of the PICC position twice a week is recommended to avoid life-threatening complications. Additionally, incorporating POCUS for identifying the tip of PICC rather than relying solely on X-ray should be considered in the current protocol.
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