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Intra-abdominal extravasation complicating parenteral nutrition in infants
S Nour1, J W Puntis, M D Stringer
1Department of Paediatric Surgery, Leeds General Infirmary.
Insights
Two infants experienced acute abdomen due to total parenteral nutrition (TPN) extravasation from central venous catheters. Prompt catheter removal led to complete recovery, highlighting a critical complication of TPN in neonates.
Area of Science:
- Pediatrics
- Neonatal Care
- Surgical Complications
Background:
- Total parenteral nutrition (TPN) is a life-sustaining therapy for infants unable to receive enteral nutrition.
- Central venous catheters are commonly used for TPN administration, with the inferior vena cava being a frequent placement site.
- Potential complications associated with central venous catheters include infection, thrombosis, and malposition.
Observation:
- Two infants receiving TPN via a central venous catheter in the inferior vena cava presented with acute abdominal symptoms.
- Extravasation of the TPN infusate was identified as the cause of the acute abdomen.
- One infant developed an abdominal mass requiring surgical intervention (laparotomy).
Findings:
- TPN extravasation from an inferior vena cava catheter can lead to severe abdominal complications in infants.
- The clinical presentation included acute abdomen and, in one case, a significant abdominal mass.
- Complete resolution of symptoms and recovery occurred after the removal of the malfunctioning central venous catheter.
Implications:
- This case series underscores the importance of vigilant monitoring for TPN extravasation in infants with central venous catheters.
- Early recognition and prompt removal of the catheter are crucial for managing this potentially life-threatening complication.
- Healthcare providers should consider TPN extravasation in the differential diagnosis of acute abdomen in infants receiving central venous TPN.
Abstract:
Two infants receiving total parenteral nutrition via a central venous catheter positioned in the inferior vena cava developed an acute abdomen secondary to extravasation of the infusate. The presence of an associated abdominal mass necessitated a laparotomy in one patient. Both infants recovered completely after the catheter had been removed.