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Wang J, Wang Q, Liu Y, Lin Z, Janjua MU, Peng J, Du J. The incidence and mortality rate of catheter-related neonatal pericardial effusion: A meta-analysis. Medicine (Baltimore) 2022; 101:e32050. [PMID: 36451499 PMCID: PMC9704876 DOI: 10.1097/md.0000000000032050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUD Neonatal pericardial effusion (PCE) is one of the most severe complications of central catheters in neonates with its rapid progression and high mortality. We aim to estimate the overall incidence and mortality of catheter-related neonatal PCE, more importantly, to identify possible predictors for clinical reference. METHODS We searched MEDLINE, Embase, Cochrane Library, Web of Science, china national knowledge infrastructure, Wanfang Data, and Sinomed databases for subject words "central catheter," "neonate," "pericardial effusion" and their random words till June 8, 2020. This meta-analysis is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Possible predictors of occurrences and deaths were extracted and assessed cooperatively. The pooled incidence rate of catheter-related neonatal PCE was calculated using a random effects model. RESULTS Twenty-one cohort studies and 99 cases were eligible. Pooled incidence is 3·8‰[2.2‰, 6.7‰]. Polyurethane catheters generate significantly more neonatal PCE than silicone counterparts (P < .01). 27% of the patients die. The mortality of patients with bradycardia is higher than others (P < .05). Catheters with a guidewire result in more deaths than umbilical venous catheter (UVC) and peripherally inserted central catheters (PICC) (P < .05). Without pericardiocentesis, mortality increases (P < .01). The difference of deaths between reposition and removing the catheter is insignificant (P > .05). CONCLUSION Central catheters in Seldinger Technique (with a guidewire) put neonates at greater risk of PCE and consequent death. Silicone catheters excel at avoiding deadly catheter-related PCE, which could be a better choice in neonatal intensive care units (NICU). When catheter-related PCE occurs, timely diagnosis and pericardiocentesis save lives.
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Affiliation(s)
- Jingyi Wang
- The First Clinical Medical Institute, Hainan Medical University, Hainan, China
| | - Qing Wang
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Yanxia Liu
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Zebin Lin
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Muhammad Usman Janjua
- International Education Institute, Changsha Medical University, Changsha, Hunan, China
| | - Jianxiong Peng
- Medical Administration Department, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Jichang Du
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
- * Correspondence: Jichang Du, Department of Neonatology, Hainan Modern Women and Children’s Hospital, No. 18 Qiongzhou Avenue, Qiongshan District, Haikou, Hainan 571101, P.R. China (e-mail: )
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Hou A, Fu J. Pericardial Effusion/Cardiac Tamponade Induced by Peripherally Inserted Central Catheters in Very Low Birth Weight Infants: A Case Report and Literature Review. Front Pediatr 2020; 8:235. [PMID: 32500049 PMCID: PMC7242726 DOI: 10.3389/fped.2020.00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Although pericardial effusion/cardiac tamponade (PCE/CT) is a rare complication of peripherally inserted central catheters (PICCs), with an incidence of 0. 07-2%, it is associated with high mortality and is often life threatening. We sought to improve understanding of PICC-induced PCE/CT among pediatricians. Case presentation: The clinical data of PICC-associated PCE/CT in a very low birth weight (VLBW) infant were summarized, and the relevant literature was also reviewed. Conclusions: In VLBW infants with a PICC, if unstable respiratory circulatory system states are observed that cannot be explained, such as tachycardia, bradycardia, apnea, hypotension, and metabolic acidosis, PICC-induced PCE/CT should be considered. Early diagnosis and pericardial puncture are key to saving infants' lives.
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Affiliation(s)
- Ana Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianhua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Arul GS, Livingstone H, Bromley P, Bennett J. Ultrasound-guided percutaneous insertion of 2.7 Fr tunnelled Broviac lines in neonates and small infants. Pediatr Surg Int 2010; 26:815-8. [PMID: 20549506 DOI: 10.1007/s00383-010-2616-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Insertion of permanent central venous access (Broviac line) can be a challenge in neonates especially when sites for peripherally inserted central catheters (PICC) have been exhausted. The landmark technique (LT) has been well described for the percutaneous insertion of central lines in neonates but can be associated with significant complications including death. The use of the ultrasound-guided approach for temporary central line access has been reported but as yet there are no reports of the adaptation of the technique for Broviac line insertion in neonates. METHOD A prospective database records all procedures carried out by the vascular access team and any complications which occur; this database was reviewed from November 2004 to January 2008. RESULTS A consecutive series of 34 neonates underwent insertion of 36 Broviac lines using the ultrasound-guided percutaneous technique with a 2.7 Fr silastic line and a 3 Fr peel-apart sheath. Median gestational age was 34 weeks (range 24-40), chronological age was 102 days (14-209 days), weight 2.9 kg (0.63-4.1). Successful cannulation occurred in 100% of patients. There were no cases of arterial puncture or perioperative complications due to surgery. CONCLUSION The ultrasound-guided percutaneous approach for insertion of tunnelled permanent vascular access is safe in neonates with no surgical complications in our series. However, it is a technically demanding procedure to do in neonates and should not be attempted without significant prior experience.
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Affiliation(s)
- G S Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK.
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Weil BR, Ladd AP, Yoder K. Pericardial effusion and cardiac tamponade associated with central venous catheters in children: an uncommon but serious and treatable condition. J Pediatr Surg 2010; 45:1687-92. [PMID: 20713221 DOI: 10.1016/j.jpedsurg.2009.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 11/11/2009] [Accepted: 11/12/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE Pericardial effusion (PCE) resulting in cardiac tamponade (CT) is a rare complication associated with central venous catheters (CVCs) in children. The goal of this study was to determine the demographics, presenting clinical picture and CVC characteristics in children developing CT as a result of a CVC. METHODS An institutional review board-approved retrospective review of children treated at a tertiary-care pediatric hospital from 1998 to 2007 was conducted. Patients were identified through institutional database search for diagnostic codes of PCE and simultaneously assigned patient codes for the presence of CVC. Patients with incidentally discovered effusions, those with recent cardiac surgery, or those with causative factors other than a CVC were excluded. RESULTS Over the 10-year study period, 463 patients were identified using the search criteria. Six cases of CVC-associated PCE causing CT were identified (1.3%). Corrected postgestational age at diagnosis ranged from 34 to 41 weeks with a median corrected postgestational age of 38.5 weeks (median, 38.5 weeks). The median time from CVC placement to diagnosis was 2.5 days (range, 0-6 days). Radiographs obtained before diagnosis demonstrated CVC tip to be overlying the cardiac silhouette in 5 patients (83%). Five (83%) of the 6 patients were receiving hyperalimentation via the CVC at the time of PCE. All patients presented with clinical signs of cardiorespiratory distress and/or cardiac arrest. Pericardiocentesis was performed in 5 patients (83%) and resulted in rapid stabilization. All CVCs were removed at diagnosis. There was 1 mortality (17%). CONCLUSIONS Pericardial effusion and CT associated with CVC is rare and is chiefly a concern among infants. Characteristics of CVCs including infusate and tip position may be associated with increased risk of PCE. This diagnosis should be considered in any infant with a CVC who experiences acute respiratory distress or cardiovascular collapse.
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Affiliation(s)
- Brent R Weil
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Avanzini S, Guida E, Conte M, Faranda F, Buffa P, Granata C, Castagnola E, Fratino G, Mameli L, Michelazzi A, Pini-Prato A, Mattioli G, Molinari AC, Lanino E, Jasonni V. Shifting from open surgical cut down to ultrasound-guided percutaneous central venous catheterization in children: learning curve and related complications. Pediatr Surg Int 2010; 26:819-24. [PMID: 20563872 DOI: 10.1007/s00383-010-2636-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Tunneled indwelling central venous catheters (CVC) are essential in the management of children with cancer, hematological, nephrological disorders and for parenteral nutrition. The aim of this study is to present the experience of a single center of the transition from traditional open surgical cut down procedure (OSC) to ultrasound (US)-guided percutaneous CVC insertion, focusing on learning curve and related complications. METHODS All CVCs inserted between April 2008 and November 2009 in children at the Gaslini Children Hospital were revised, and data on methods of cannulation, intraoperative and device-related complications and re-intervention were recorded. RESULTS 194 CVCs were positioned in 188 patients. 128 out of 194 CVCs were positioned through an OSC technique, whereas the remaining 66 CVCs were inserted percutaneously with US guidance. Of the 27 recorded complications, 15 were mechanical events, 7 cases developed infection, whereas the remaining 5 (2.6%) were classified as intraoperative complications. A second surgical procedure was described in 23 (11.8%) cases. CONCLUSION Shifting from OSC to US-guided percutaneous CVC insertion inevitably involves a challenging learning curve which is generally associated with high complication rates. Complications progressively decrease once a good experience in US guidance and percutaneous technique has been obtained.
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Affiliation(s)
- S Avanzini
- Paediatric Surgery Department, G. Gaslini Children Hospital, Genoa, Italy.
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Arul GS, Lewis N, Bromley P, Bennett J. Ultrasound-guided percutaneous insertion of Hickman lines in children. Prospective study of 500 consecutive procedures. J Pediatr Surg 2009; 44:1371-6. [PMID: 19573664 DOI: 10.1016/j.jpedsurg.2008.12.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 12/02/2008] [Accepted: 12/02/2008] [Indexed: 11/30/2022]
Abstract
AIM The ultrasound-guided percutaneous technique of Hickman line insertion has not been widely adopted in pediatric surgical practice. We wished to review our own experience of using this technique for insertion into the internal jugular vein. METHODS Our vascular access team consists of a consultant surgeon and 2 consultant anesthetists. All procedures were prospectively recorded on a database and were either performed or directly supervised by our team. RESULTS Five hundred consecutive Hickman lines were inserted between June 2004 and October 2006. Patients' ages ranged from 14 days to 19 years (median, 44 months). Patients weighed between 600 g to more than 100 kg. Lines inserted were all tunneled silicone Hickman lines with a Dacron cuff (size 2.7F-10F, with 1-3 lumens), of which 60% were 7F double-lumen lines. Successful cannulation occurred in 99.8%. Perioperative complications (within 30 days) occurred in 12 patients (2.4%) and were all treated conservatively with no need for either blood transfusion or chest drain. Catheter-related sepsis rate was 3.16 per 1000 line days. DISCUSSION 1. The technique of ultrasound-guided percutaneous insertion of Hickman line to the internal jugular vein is safe and is applicable to all children regardless of size, age, or diagnosis. 2. Pediatric surgeons and anesthetists can learn this technique without specific training in interventional radiology. 3. A learning curve does exist, and we recommend concentrating pediatric vascular access procedures to a specialist team.
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Affiliation(s)
- G Suren Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH Birmingham, UK
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Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002; 110:137-42. [PMID: 12093959 DOI: 10.1542/peds.110.1.137] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the clinical presentation, cause, and outcome of central venous catheter (CVC)-related pericardial effusions (PCE) in infants. METHODS A retrospective case review was conducted of CVC-related PCE at university and private neonatal intensive care units. Data from our cases were combined with published case reports and included clinical presentation and outcome; biochemical evaluation of pericardial fluid; days until diagnosis; cardiothoracic ratios; and CVC characteristics, insertion site, and tip placement site. RESULTS In our cases, 6 different neonatology groups cared for 14 patients at 6 different hospitals in 2 cities. These data were combined with 47 cases reviewed from the literature. Pericardial fluid was obtained in 54 cases from the combined group and was described qualitatively as consistent with the infusate in 53 of 54 cases (98%). Biochemical analysis was performed in 37 cases, and in 36 of 37 cases (97%), the pericardial fluid was consistent with the infusate. The median gestational age at birth was 30.0 weeks (range: 23.5-42). The median time from CVC insertion to diagnosis was 3.0 days (range: 0.2-37; n = 59). Sudden cardiac collapse was reported in 37 cases (61%), and unexplained cardiorespiratory instability was reported in 22 cases (36%). The CVC tip was last reported within the pericardial reflections on chest radiograph in 56 cases (92%) at the time of PCE diagnosis. The mean cardiothoracic ratio increased 17% (n = 14). No patients died among our cases. Among the reviewed cases, 45% mortality was reported. For the combined group, mortality was 34%. For the combined group, mortality was 8% (3 of 37) in the patients who underwent pericardiocentesis versus 75% (18 of 24) for the patients who did not. In 21 patients, the catheter was withdrawn and remained in use. Survivors and nonsurvivors had comparable gestational age at birth, birth weight, days to PCE diagnosis, and day of life of PCE symptoms/diagnosis. Access site, catheter type, and catheter size were not associated with mortality. An association between larger catheters and shorter time to PCE may be present. Access site and catheter type were not associated with time to PCE. Autopsy specimens reported 6 cases of myocardial necrosis/thrombus formation, 9 cases of perforation without myocardial necrosis/thrombus formation, and 2 cases in which both were reported. CONCLUSIONS The pericardial fluid found in CVC-associated PCE is consistent with the infusate. We speculate that there are several mechanisms, ranging from frank perforation that seals spontaneously to CVC tip adhesion to the myocardium with diffusion into the pericardial space. Routine radiography should be performed, and the CVC tip should be readily identifiable. The CVC tip should remain outside the cardiac silhouette but still within the vena cavae (approximately 1 cm outside the cardiac silhouette in premature infants and 2 cm in term infants). A change in cardiothoracic ratio may be diagnostic of a PCE, and pericardiocentesis is associated with significantly reduced mortality. Increased awareness of this complication may decrease the mortality associated with CVC-related PCE.
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Affiliation(s)
- Todd T Nowlen
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
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Darling JC, Newell SJ, Mohamdee O, Uzun O, Cullinane CJ, Dear PR. Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol 2001; 21:461-4. [PMID: 11894516 DOI: 10.1038/sj.jp.7210541] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fatal cardiac tamponade is a well recognised complication of the use of central venous catheters in neonatal patients. There is controversy over optimum catheter tip position to balance catheter performance against risk of adverse events. We report a series of five cases of tamponade occurring in one neonatal unit over a 4-year period, related to catheter tip placement in the right atrium. Right atrial catheter angulation, curvature or looping (CA) was present in all five cases on plain radiograph. It was frequently seen in other patients over the same period. Review of the literature indicates that CA was present in 6 of the 11 previous cases where the presence or absence of CA can be determined. Where right atrial catheter tip placement is accepted, clinicians should be aware of this characteristic catheter configuration, which is a major risk factor for cardiac tamponade. We recommend that catheter tips should not be placed in the right atrium to avoid risk of tamponade.
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Affiliation(s)
- J C Darling
- Department of Paediatrics and Child Health, University of Leeds and United Leeds Teaching Hospitals Trust, Leeds, UK
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Cade A, Puntis JW. Pericardial parenteral nutrition infusion following acute angulation of a neonatal polyurethane central venous catheter tip. Clin Nutr 1997; 16:263-4. [PMID: 16844606 DOI: 10.1016/s0261-5614(97)80039-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/1997] [Accepted: 07/11/1997] [Indexed: 11/29/2022]
Abstract
Life threatening cardiac tamponade developed in a premature infant due to perforation of the heart by a 2F central venous catheter used to administer parenteral nutrition. Abnormal orientation of the catheter tip preceded the appearance of the pericardial effusion. Unusual angulation of the tip of central venous lines in premature infants may be an important warning sign of impending cardiac perforation and its potentially major sequelae and should therefore prompt immediate repositioning of the catheter.
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Affiliation(s)
- A Cade
- Department of Paediatrics and Child Health, D Floor, Clarendon Wing, General Infirmary at Leeds, Belmont Grove, Leeds, LS2 9NS, UK
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Stanek J, Willett GD, Lage JM. Idiopathic hydropericardium as a cause of death of a preterm neonate. PEDIATRIC PATHOLOGY 1993; 13:1-8. [PMID: 8474947 DOI: 10.3109/15513819309048186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report a case of a very premature infant who died on day 17 of life because of clinically unsuspected cardiac tamponade due to a pericardial effusion with no gross or microscopic features of myocardial inflammation or perforation. The pericardial effusion probably accumulated for 8 days prior to his death, as evidenced by chest X-ray films. The only relevant microscopic finding was a prominent pericardial and myocardial interstitial edema. Although Staphylococcus epidermidis line sepsis, central venous catheter trauma, hypoalbuminemia, anemia, and heart failure could be possible contributory factors, no definitive cause of the pericardial effusion was found and the etiology of this condition remains obscure.
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Affiliation(s)
- J Stanek
- Department of Pathology, Georgetown University Medical School, Washington, DC 20007
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Aiken G, Porteous L, Tracy M, Richardson V. Cardiac tamponade from a fine silastic central venous catheter in a premature infant. J Paediatr Child Health 1992; 28:325-7. [PMID: 1323318 DOI: 10.1111/j.1440-1754.1992.tb02679.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 790 g infant developed cardiac tamponade 17 h after starting parenteral nutrition through a fine silastic catheter, the tip of which was accidentally positioned against the wall of the right atrium. Cold light examination suggested the diagnosis and pericardial aspiration of clear fluid with a high glucose content restored the circulation.
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Affiliation(s)
- G Aiken
- Neonatal Unit, Wellington Hospital, New Zealand
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12
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Giacoia GP. Cardiac tamponade and hydrothorax as complications of central venous parenteral nutrition in infants. JPEN J Parenter Enteral Nutr 1991; 15:110-3. [PMID: 1901100 DOI: 10.1177/0148607191015001110] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The recent use of soft catheters made of silastic polymeric silicone or polyurethane has decreased the incidence of perforation of great veins or right-sided heart chambers but has not eliminated it as had been hoped. Two premature infants who presented with cardiac tamponade more than 24 hr after the insertion of a 23-gauge silastic catheter for total parenteral nutrition (TPN) administration are described. In one infant, bilateral hydrothorax preceded the occurrence of cardiac tamponade. Osmotic injury to great vessels and/or myocardium seems to be the common mechanism but which these complications of intraluminal catheters are produced. Review of the pediatric literature revealed a proportion of low birth weight infants among the reported cases. Despite a prohibitively high mortality rate, early recognition can prevent a fatal outcome.
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Affiliation(s)
- G P Giacoia
- Department of Pediatrics, University of Oklahoma College of Medicine, Tulsa
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13
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Kovar IZ, Morgan JB. Parenteral nutrition in the preterm infant. Clin Nutr 1990; 9:57-63. [PMID: 16837333 DOI: 10.1016/0261-5614(90)90054-v] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/1988] [Accepted: 03/08/1989] [Indexed: 11/25/2022]
Affiliation(s)
- I Z Kovar
- Departments of Child Health, Charing Cross and Westminster Medical School, London, UK
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14
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Abstract
The ever-changing complexion of iatrogenic perinatal disease dictates the following: 1. Neonatologists and pediatric pathologists must be aware of the current spectrum of these lesions and ever alert to the appearance of new ones. 2. The neonatologist and pediatric pathologist within any given institution should be in regular, systematic communication with each other concerning lesions of this type. 3. There must be a national network for rapid dissemination or exchange of information among institutions regarding these lesions. The Study Group for the Complications of Perinatal Care (SGCPC), established in 1984 as an international, multicenter, multidisciplinary study group, is committed to the prevention of complications of perinatal care by individual and collective effort. Its individual members include perinatologists, neonatologists, pediatric pathologists, and obstetricians. There are institutional members as well. Activities to date include the development of a standardized perinatal autopsy protocol and the initiation of a uniform system for the categorization of perinatal deaths. If the reader is interested in obtaining further information about the organization, contact Trevor Macpherson, MD, in the Department of Pathology at the Magee-Womens Hospital in Pittsburgh, Pennsylvania.
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Abstract
In a retrospective survey of vascular access by means of central venous catheters, those inserted via a tunnel lasted four times longer than those inserted directly into a vein. The latter were four times more likely to become infected. The general health of patients receiving chemotherapy resulted in frequent episodes of sepsis and one-third of all catheters were removed because of presumed infection. There were no complications relating to insertion, which was by direct exposure of a central vein, preferably the right internal jugular. Long-term atrial catheters were not associated with major venous thrombosis or cardiac complications. Safe vascular access is an important contribution to the management of children with malignant disease, notwithstanding the high infection rate. A specially trained nurse, working closely with experienced play leaders and social workers, minimises the technical and psychological problems associated with long-term central venous catheters.
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Long R, Kassum D, Donen N, De Pape A, Taylor J, Warrian K. Cardiac tamponade complicating central venous catheterization for total parenteral nutrition: A review. J Crit Care 1987. [DOI: 10.1016/0883-9441(87)90119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Collier PE, Ryan JJ, Diamond DL. Cardiac tamponade from central venous catheters. Report of a case and review of the English literature. Angiology 1984; 35:595-600. [PMID: 6486523 DOI: 10.1177/000331978403500909] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of acute cardiac tamponade caused by an internal jugular central venous catheter which was successfully treated is reported. The English literature is reviewed and shows that tamponade can occur up to 37 days after insertion and has a 65% mortality. The tamponade is usually caused by the actual infusate and not by blood.
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Wright JE. Hydrothorax: a delayed complication of parenteral nutrition via a central venous catheter. AUSTRALIAN PAEDIATRIC JOURNAL 1982; 18:216-8. [PMID: 6817743 DOI: 10.1111/j.1440-1754.1982.tb02033.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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