Recurrent bilateral pleural effusions secondary to superior vena cava obstruction as a complication of central venous...

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Medical Device Complications

Background:

• Central venous catheters (CVCs) are essential for neonatal care but associated with complications.
• Pleural effusions are a rare but serious complication of CVC use in neonates.
• The pathophysiology of CVC-induced pleural effusions requires further elucidation.

Purpose of the Study:

• To describe a series of neonates who developed bilateral pleural effusions secondary to CVC use.
• To investigate the potential mechanisms, including venous obstruction and catheter material, contributing to these effusions.
• To evaluate the impact of catheter sterilization methods on fibrin deposition and potential thrombosis.

Main Methods:

• Case series of five neonates with bilateral pleural effusions following CVC placement.
• Clinical data collection including fluid analysis, imaging (venograms), and autopsy findings.
• In vivo animal study using Silastic catheters (gas-sterilized vs. autoclaved) to assess fibrin deposition via electron microscopy.

Main Results:

• Pleural effusions developed 7-19 days post-CVC placement/change, requiring frequent thoracenteses.
• Fluid analysis revealed transudate that became chylous with feeding.
• Venograms and autopsies showed superior vena cava obstruction with collateral drainage.
• Electron microscopy demonstrated significant fibrin deposition on gas-sterilized catheters, minimal on autoclaved ones.

Conclusions:

• Pleural effusions in this cohort resulted from thoracic lymphatic flow obstruction into the venous system.
• Superior vena cava thrombosis, potentially exacerbated by sterilization residues (ethylene oxide), is implicated.
• Autoclaved catheters showed reduced fibrin deposition, suggesting a safer sterilization method.