Catheter-related complications of total parenteral nutrition in infants

Trimming of Peripherally Inserted Central Catheters: The End Result

A debate surfaced in the neonatal literature over two years ago questioning the safety and efficacy of trimming peripherally inserted central catheters (PICCs) prior to insertion. An investigation was undertaken to define the risks and benefits of doing so and evaluate the methods of trimming PICCs. When trimmed by 1 of 3 methods, conclusive evidence revealed that the method of catheter trimming affects the integrity of the catheter tip. Additional study is required to determine whether catheter tip alteration impacts patient outcomes.

Venopelvic fistula: a rare complication of hyperalimentation

The prolonged placement of a hyperalimentation catheter via the left great saphenous vein resulted in obstruction of the inferior vena cava and in the formation of a venopelvic fistula. Administration of hyperosmolar fluid via this catheter might be the cause of this complication.

Central line perforation associated with Staphylococcus epidermidis infection

We present detailed case reviews of four very low birth weight (VLBW) infants in whom central venous silastic catheter perforation was associated with Staphylococcus epidermidis sepsis. The diagnostic and therapeutic dilemma presented by the intracavitary fluid collections occurring in all four of these cases proved to be of clinical interest. Additionally, we propose a model that may account for the etiology of catheter displacement--localized phlebitis as a result of S epidermidis infection with resultant extralumenal migration of the central venous catheter.

Silastic catheterization of the axillary vein in neonates: an alternative to the internal jugular vein

The axillary vein is a suitable alternative to the jugular venous system for tunnelled silastic catheterization in neonates, and should be included in the armamentarium of the surgeon who treats neonates. It is technically easy and is comparable to the internal jugular vein in terms of complications. Proper positioning of the catheter tip can sometimes be problematic, but without a resultant increase in morbidity or mortality.

Spinal canal extension of hyperalimentation catheter without neurologic sequela

An attempt at placement of a left femoral vein hyperalimentation catheter resulted in entrance of the catheter into the spinal canal. Catheter location was documented by injections of nonionic contrast material into the catheter without neurologic sequellae.

Acquired bone dysplasia secondary to catheter-related complications in the neonate

Four neonates presented with leg-length discrepancy in the first and second year of life, secondary to physeal growth arrest. All four had stormy postnatal periods, requiring indwelling arterial and/or hyperalimentation catheters. One had documented osteomyelitis. In the last three cases, the growth disturbance may have been secondary to aseptic emboli to the bones from the indwelling catheters. In two cases, there was evidence of other nonseptic embolic phenomena.

Total intravenous hyperalimentation (TIH) complications in childhood: a radiological survey

Sixty consecutive patients, except for one 7-year-old patient, their ages varying from 1 day to 12 months received total intravenous hyperalimentation (TIH). It was possible to observe non-pathological catheter malpositions and, in 14 patients, other complications. The most serious complications observed included the following: thrombus and pericatheter thrombus calcification; superior vena cava thrombotic occlusion; hydrothorax; mediastinal effusion; generalized septic arthritis; venous transfixion with flooding of the soft tissues of the neck; vein wall lesions; collateral vertebral circulation; and a catheter tip blocked in vein. A brief comment is given on the use of this procedure and what may happen.

Superior vena cava syndrome in childhood and adolescence: a review of the literature and report of three cases

Obstruction of the superior vena cava is rare in childhood and adolescence. Its etiology is now mainly iatrogenic. Mediastinal tumors are the main primary causes of the superior vena cava syndrome (SVCS) in childhood and adolescence. The most common mediastinal tumors presenting with the SVCS are the lymph node tumors and especially the lymphosarcomas. About 50% of the mediastinal tumors are primary in the mediastinum. Early treatment is designed to cause a rapid shrinking of the tumor and should not be delayed by an overly diligent pursuit of the diagnosis. Treatment should consist of a combination of radiation therapy, chemotherapy, and steroids. Surgery should be limited to obtaining tissue for diagnosis, except when the tumor is localized to the mediastinum and is completely resectable. One hundred and seventy two children and adolescents with the SVCS are reviewed and three patients are added.

Development of hypervitaminosis A in a patient on long-term parenteral hyperalimentation

A four and one-half year old boy with intestinal pseudo-obstruction who had been maintained on parenteral hyperalimentation for one year developed classical signs of hypervitaminosis A. This diagnosis was confirmed radiographically; serum vitamin A levels were five times normal. The patient had a dramatic response to withdrawal of vitamin A from the hyperalimentation fluid.

Hyperalimentation catheter passing into the spinal canal causing temporary paraplegia

A patient with a hyperalimentation catheter in the spinal canal is presented. This resulted in an extradural fluid mass and partial paraplegia that eventually cleared.

Catheter-induced ascites--an unusual complication of parenteral feeding

A nearly fatal complication of parenteral feeding is reported. An emaciated infant with severe Shigella dysentery was treated with intravenous feeding through a catheter in the inferior vena cava. After three days severe ascites developed acutely. Venocavography revealed effusion into the peritoneal cavity due to the catheter having penetrated the wall of the inferior vena cava.