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Sharpe EL, Curry S, Wyckoff MM. NANN Neonatal Peripherally Inserted Central Catheters: Guideline for Practice, 4th ed. Adv Neonatal Care 2024; 24:313-315. [PMID: 39052577 DOI: 10.1097/anc.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Elizabeth Li Sharpe
- College of Nursing, The Ohio State University, Columbus, Ohio (Dr Sharpe); Neonatal Intensive Care Unit, Arkansas Children's Hospital, Little Rock, Arkansas (Ms Curry); and College of Nursing, and Doctor of Nursing Practice Program, Samuel Merritt University, Sacramento, California (Dr Wyckoff)
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Zhu XJ, Zhao L, Peng N, Luo JM, Liu SX. Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein: A case report. World J Clin Cases 2024; 12:1430-1436. [PMID: 38576810 PMCID: PMC10989445 DOI: 10.12998/wjcc.v12.i8.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/29/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are an essential infusion route for oncology patients receiving intravenous treatments, but lower extremity venipuncture is the preferred technique for patients with superior vena cava syndrome (SVCS). We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein, to indicate and verify PICC catheterisation in the lower extremity is safe and feasible. And hope to provide different perspectives for clinical PICC venipuncture to get the attention of peers. CASE SUMMARY On 24 August 2022, a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month, which worsened 10 d prior. Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS. Chemotherapy was not an absolute contraindication in this patient. Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head, neck, and upper extremities. The patient and his family were informed about the procedure, and informed consent was obtained. After successful puncture and prompt treatment, the patient was discharged, experiencing some relief from symptoms. CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS, particularly in complex situations involving ectopic placement.
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Affiliation(s)
- Xiao-Ju Zhu
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Ling Zhao
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Na Peng
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Jia-Min Luo
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Shui-Xia Liu
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
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Jain A, Patra S, Chetan C, Gupta G. Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade. BMJ Case Rep 2024; 17:e256151. [PMID: 38367993 PMCID: PMC10875498 DOI: 10.1136/bcr-2023-256151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.
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Affiliation(s)
- Ankit Jain
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Saikat Patra
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Chinmay Chetan
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Perme T. Central Lines and Their Complications in Neonates: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 11:26. [PMID: 38255340 PMCID: PMC10814986 DOI: 10.3390/children11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI.
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Affiliation(s)
- Tina Perme
- Neonatal Intensive Care Unit, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Botelho T, Sebastião M, Dias JO, Rodrigues Silva A, Castelo R. Pericardial effusion in extremely low birthweight infants. J Paediatr Child Health 2023; 59:1332-1333. [PMID: 36645199 DOI: 10.1111/jpc.16329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/09/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023]
Affiliation(s)
- Teresa Botelho
- Neonatology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mariana Sebastião
- Neonatology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João O Dias
- Paediatric Cardiology Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rodrigues Silva
- Neonatology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Castelo
- Neonatology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Pericardial effusion in extremely low birthweight infants. J Paediatr Child Health 2023; 59:1335-1336. [PMID: 38073246 DOI: 10.1111/jpc.1_16329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/09/2022] [Accepted: 01/08/2023] [Indexed: 12/18/2023]
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Liu Z, Li R, Zhou B, Ye X, Li G. Cardiac Tamponade in an Infant With PICC: A Case Report. Clin Pediatr (Phila) 2023:99228231210729. [PMID: 37942761 DOI: 10.1177/00099228231210729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Zhengxi Liu
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Run Li
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Bo Zhou
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoxiu Ye
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Guiping Li
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
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Tao X, Zhang X, Wang J, Chen Y, Liu X. The relationship between the PICC tip position and weight gain, length growth of premature infants under ultrasonography: a correlation analysis study. Front Med (Lausanne) 2023; 10:1200033. [PMID: 37387782 PMCID: PMC10301819 DOI: 10.3389/fmed.2023.1200033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Objective This study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography. Methods The study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes. Results A total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715-975) g, length increased by 1.50 (1.00-2.12) and 3.00 (2.00-3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position. Conclusion The PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.
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Affiliation(s)
- Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianhui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Zareef R, Anka M, Hatab T, El Rassi I, Yunis K, Bitar F, Arabi M. Tamponade and massive pleural effusions secondary to peripherally inserted central catheter in neonates-A complication to be aware of. Front Cardiovasc Med 2023; 10:1092814. [PMID: 36873398 PMCID: PMC9981636 DOI: 10.3389/fcvm.2023.1092814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Background Peripherally inserted central catheters (PICC) are frequently used in neonatal intensive care units (NICU) to assist premature and critically ill neonates. Massive pleural effusions, pericardial effusions, and cardiac tamponade secondary to PICC are extremely uncommon but have potentially fatal consequences. Objective This study investigates the incidence of tamponade, large pleural, and pericardial effusions secondary to peripherally inserted central catheters in a neonatal intensive care unit at a tertiary care center over a 10-year period. It explores possible etiologies behind such complications and suggests preventative measures. Study design Retrospective analysis of neonates who were admitted to the NICU at the AUBMC between January 2010 and January 2020, and who required insertion of PICC. Neonates who developed tamponade, large pleural, or pericardial effusions secondary to PICC insertion were investigated. Results Four neonates developed significant life-threatening effusions. Urgent pericardiocentesis and chest tube placement were required in two and one patients, respectively. No fatalities were encountered. Conclusion The abrupt onset of hemodynamic instability without an obvious cause in any neonate with PICC in situ should raise suspicion of pleural or pericardial effusions. Timely diagnosis through bedside ultrasound, and prompt aggressive intervention are critical.
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Affiliation(s)
- Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Anka
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Taha Hatab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalid Yunis
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Park MJ, Ahn JH, Lee HJ, Park HK, Hwang JK, Kim CR, Na JY. Rapidly Progressive Pericardial Effusion and Cardiac Tamponade in a Term Infant with an Umbilical Venous Catheter: A Case Report. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.4.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Pericardial effusion (PCE) in neonates has various clinical presentations depending on the amount and speed of fluid accumulation and can cause cardiac tamponade (CT). We report a case of rapidly accumulating PCE and near-fatal CT with an umbilical venous catheter successfully resolved by emergent echo-guided pericardiocentesis in a term infant who had been hospitalized with meconium aspiration syndrome and persistent pulmonary hypertension. This case report suggests that if a patient with an intracardiac umbilical catheter shows sudden cardiopulmonary instability, the possibility of PCE and CT should be considered. Furthermore, if necessary, emergency drainage of the PCE and removal of the umbilical catheter should be immediately performed.
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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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Young VA, Thakor AS, Josephs SC. Update on Pediatric Interventional Radiology. Radiographics 2022; 42:1580-1597. [DOI: 10.1148/rg.220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victoria A. Young
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Avnesh S. Thakor
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Shellie C. Josephs
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
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Wang YS, Huang HC, Liu YC, Chen IL. Echocardiographic Determination of Percutaneous Central Venous Catheters in the Superior Vena Cava: A Prospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:624. [PMID: 35626801 PMCID: PMC9139769 DOI: 10.3390/children9050624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
Malposition of percutaneous central venous catheters (PCVCs) in the superior vena cava (SVC) is common. We previously showed that real-time sonography was safer and faster than radiography in identifying PCVC tip location in the inferior vena cava (IVC). However, in preterm infants, determining PCVC tip location in the SVC is complicated by endotracheal or nasogastric tubes in situ and emphysematous lung conditions. We aimed to find an appropriate sonographic view by which to assess PCVC tip location in the SVC compared to the sonographic examination of PCVC in the IVC. Neonates (n = 50) with PCVCs in the SVC were enrolled and their data (gestational age, gender, birth weight, body weight at intervention, repositioning rate, and duration of tip assessment) were compared with retrospective data of 50 neonates with PCVCs in the IVC. The mean gestational age in the groups of IVC and SVC was 31.43 weeks and 32.16 weeks, respectively. The mean birth weight in the groups of IVC and SVC was 1642.18 g and 1792.00 g, respectively. Placement of an S12-4 ultrasound sector transducer to obtain clear parasternal views of the aorta allows visualization of PCVC tips in the SVC and near the cavoatrial junction. PCVC repositioning rates were not significantly different between the two groups (p = 0.092). Sonography examinations in the SVC had a longer duration than those in the IVC (p < 0.001). Sonography provides an accurate method for determining PCVC tip location in the SVC.
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Affiliation(s)
- Yao-Sheng Wang
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi 613, Taiwan;
| | - Hsin-Chun Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (H.-C.H.); (Y.-C.L.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 333, Taiwan
| | - Yu-Chen Liu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (H.-C.H.); (Y.-C.L.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 333, Taiwan
| | - I-Lun Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (H.-C.H.); (Y.-C.L.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 333, Taiwan
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Wan R, Gu L, Yin B, Cai S, Zhou R, Yang W. A six-year study of complications related to peripherally inserted central catheters: A multi-center retrospective cohort study in China. Perfusion 2022; 38:689-697. [PMID: 35236188 DOI: 10.1177/02676591221076287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Peripherally inserted central catheters (PICCs), the most frequent central venous catheter, are used to provide medical treatments, although long-term PICC-related adverse outcomes are unknown in China. This study systematically investigated PICC-related complications in four Chinese hospitals. METHODS Between January 2014 and January 2020, we analyzed the results of 3550 patients with PICC who were referred to four Chinese hospitals. All patients underwent PICC treatment in four Chinese hospitals. Patient-reported signs and symptoms of a putative PICC-related complication or functional were studied. Long-term outcomes and hospitalization costs were also evaluated. RESULTS An aggregate of 3285 patients were enrolled in the analytic cohort. 58.6% were females and 41.4% were males. The most common reasons for PICC placement included oncologic malignancy and critically ill patients. The majority of PICCs had valved systems (90.7%) and were implanted in the right side (85.5%) and into the basilic vein (87.7%). At least one potential PICC-related problem or adverse effects (AEs) was reported by 67.3% of patients. Central line-associated bloodstream infection (28.1%) and symptomatic deep vein thrombosis (20.7%) were the most common complications. The majority of PICCs were removed for causes other than AEs, with just 723 reported AEs accounting for 22.0% of all PICC removals. The most reasons for PICCs removal were occlusion (425, 12.9%) and exit-site infections (189, 5.8%). CONCLUSIONS This study is the first retrospective study in our country to explore PICC-related complications. While living with a PICC, more than 67.3% of patients report signs and symptoms of at least one PICC-related problem or adverse impacts, such as difficulties with PICC use and poor effects on physical and social function. In this group, PICCs are safe and effective, although the danger of PICC-related problems should not be disregarded.
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Affiliation(s)
- Rong Wan
- Department of Nursing, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Lilei Gu
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Bi Yin
- Department of Physical Examination, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Shengwei Cai
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Rengui Zhou
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Weilin Yang
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
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Wu Y, Yan J, Tang M, Hu Y, Wan X, Li X, Chen Q, Li X. A review of neonatal peripherally inserted central venous catheters in extremely or very low birthweight infants based on a 3-year clinical practice: Complication incidences and risk factors. Front Pediatr 2022; 10:987512. [PMID: 36389348 PMCID: PMC9659812 DOI: 10.3389/fped.2022.987512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The application of peripherally inserted central venous catheters (PICCs) in neonates has proven effective in avoiding repetitive insertions and excessive use of transfusion consumables. However, the frequent occurrence of PICC-associated complications deserves special attention, especially in extremely or very low birthweight (E/VLBW) infants, which in turn affects the quality of neonatal PICC practice. Therefore, we conducted a retrospective study of a 3-year clinical practice of neonatal PICCs in E/VLBW infants to understand the incidences of various catheter-related complications and their risk factors to help form an empirical summary and evidence-based guidance for the improvement of practice. METHODS A retrospective study was conducted based on a 3-year practice of neonatal PICCs in E/VLBW infants. Neonatal health records were collected, including demographic characteristics, PICC placement data, and treatment information. RESULTS A total of 519 E/VLBW infants were included in this study. There were 77 cases of complications involving 72 infants with an overall incidence of 12.13%. The order of incidences of different complications from high to low was phlebitis (7.71%), malposition (3.66%), leakage (1.35%), pleural effusion (1.15%), central line-associated bloodstream infection (0.58%, 0.25/1,000d), and accidental removal (0.38%). Multivariate analysis revealed that the inserted vessel was an independent risk factor for PICC-associated complications (mainly phlebitis; p = 0.002). Neonatal PICCs inserted in the axillary vein were only one-tenth (p = 0.026) as likely to cause phlebitis as in the basilic vein, whereas when applied in the saphenous vein, neonatal PICCs were five times as likely to cause phlebitis (p = 0.000). CONCLUSION E/VLBW infants might be more inclined to develop PICC-associated phlebitis. Catheters inserted in the axillary or basilic vein are preferred if possible.
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Affiliation(s)
- Yaohua Wu
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jing Yan
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Mengyan Tang
- Department of Child Healthcare Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yanling Hu
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xingli Wan
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaowen Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qiong Chen
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xia Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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16
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Georgeades C, Rothstein AE, Plunk MR, Arendonk KV. Iatrogenic vascular trauma and complications of vascular access in children. Semin Pediatr Surg 2021; 30:151122. [PMID: 34930587 DOI: 10.1016/j.sempedsurg.2021.151122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States.
| | - Abby E Rothstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701W. Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin and Medical College of Wisconsin, 9000W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
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17
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Goli R, Zafarmokhtarian S, Ghalandari M, Babakeshi-Sheytanabad N, Rostami S, Farajollahi H. Pneumothorax as a rare complication of peripherally inserted central catheter (PICC) in neonates: A case report study. Int J Surg Case Rep 2021; 88:106472. [PMID: 34637990 PMCID: PMC8506958 DOI: 10.1016/j.ijscr.2021.106472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction and importance The Peripherally Inserted Central Catheter (PICC) placement is associated with complications such as deep vein thrombosis, phlebitis, air embolism, infection, and superior vena cava syndrome. The aim of this study is to report pneumothorax as a rare complication of PICC insertion in a newborn. Case presentation The present case report is of a 32-week- and 4-day-old female fetus who was born at Mahzad Obstetrics and Gynecology Hospital, Urmia, Iran. A PICC was placed for the infant. The infant underwent an antero–posterior chest X-ray, in which the presence of a complete white-out of the right hemithorax indicated pneumothorax and right lung collapse. The review of literature in this field showed that there were no reports of pneumothorax as a complication of PICC insertion in neonates. Clinical discussion Despite that the PICC placement seems to have many medical advantages in infants, it may cause life-threatening complications such as pneumothorax. In this newborn, the PICC placement was the main cause of pneumothorax and it can be stated that the catheter tip might cause trauma to the chest wall during the placement procedure which resulted in an air trap in the pleural cavity and eventually right lung collapse. Conclusion There are a couple of rare cases being reported to have complications of PICC placement in neonates, but none had associated pneumothorax and PICC placement in neonates. Therefore, innovative methods require to be used for meeting the nutrition and fluid requirements of the infants for a long time. PICC placement is associated with life-threatening complications. Pneumothorax is a rare complication of PICC placement in neonates. Innovative methods are required for neonate’s nutrition requirements for a long time.
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Affiliation(s)
- Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sina Zafarmokhtarian
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Marand, East Azerbaijan, Iran
| | - Mahmoodreza Ghalandari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Sajjad Rostami
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Zanjan, Zanjan, Iran
| | - Hossna Farajollahi
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Zanjan, Zanjan, Iran
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18
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Stringer BJ, Shumway SB, Willden JP, Kuck K. Joint time-frequency analysis of visible laser reflections in a sheep heart. JOURNAL OF BIOPHOTONICS 2021; 14:e202000464. [PMID: 33934517 DOI: 10.1002/jbio.202000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Limited methods exist to confirm the position of cardiovascular devices in the superior vena cava or right atrium of the heart. The aim of this study was to design, test and validate the feasibility of whether an optical fiber-based instrument could accurately distinguish when a cardiovascular catheter was located in the superior vena cava vs in the right atrium. An optical fiber was placed in a cardiovascular catheter which was inserted into a living sheep and guided to the vicinity of the heart where diode laser-based reflection intensity data were simultaneously gathered from two visible wavelengths of light reflected from the venous and atrial tissue surfaces near the cavoatrial junction. The time series data were postoperatively analyzed using methods of joint time-frequency analysis and validated against catheter positions determined with fluoroscopy and ECG. The system was successful in distinguishing the location of the superior vena cava from the right atrium.
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Affiliation(s)
- Bradley J Stringer
- Verum TCS, LLC, Ridgefield, Washington, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Kai Kuck
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
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19
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Huseynova RA, A. Bin Mahmoud L, AlHemiad M, Almuhaini M, Huseynov O. Early pericardial effusion as complication of umbilical venous catheter insertion in extreme preterm baby: A case report. Clin Case Rep 2021; 9:2109-2112. [PMID: 33936648 PMCID: PMC8077324 DOI: 10.1002/ccr3.3957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
Reminder essential clinical practice: Pericardial effusion is a rare fatal condition, however potentially reversible when grasped in time. It should always be thought out in neonate with a central line who develops unexplained cardiorespiratory failure.
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Affiliation(s)
| | | | | | - Muath Almuhaini
- King Saud Medical City King Saud Medical CityRiyadhSaudi Arabia
| | - Oqtay Huseynov
- Azerbaijan Medical University Nariman NarimanovBakuAzerbaijan
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20
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[Operation and management guidelines for peripherally inserted central catheter in neonates (2021)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021. [PMID: 33691911 DOI: 10.7499/j.issn.1008-8830.2101087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Peripherally inserted central catheter (PICC) has been widely used in the neonatal intensive care unit (NICU) in recent years, but there are potential risks for complications related to PICC. Based on the current evidence in China and overseas, the operation and management guidelines for PICC in neonates were developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in order to help the NICU staff to regulate the operation and management of PICC.
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21
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张 雅, 刘 云, 童 笑, 陆 丹, 石 诗. [A clinical analysis of pericardial effusion caused by central venous catheterization in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:259-264. [PMID: 33691919 PMCID: PMC7969199 DOI: 10.7499/j.issn.1008-8830.2011089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the clinical features of pericardial effusion caused by central venous catheterization in preterm infants. METHODS A retrospective analysis was performed on 11 preterm infants with pericardial effusion caused by central venous catheterization. Their catheterization features, manifestations, treatment, and prognosis were analyzed. RESULTS A total of 11 preterm infants (11/2 599, 0.42%) developed pericardial effusion, with a mean gestational age of (30.1±2.6) weeks and a mean birth weight of (1 240±234) g. Pericardial effusion mostly occurred within 4 days after central venous catheterization (10 cases, 91%). The main manifestations included poor response (6/11, 55%), cyanosis (5/11, 45%), increased respiratory rate (6/11, 55%), increased heart rate (6/11, 55%), aggravated dyspnea (5/11, 45%), and muffled heart sound (5/11, 45%). At the time of disease progression, 7 preterm infants (64%) had a deep position of the end of the catheter, 3 preterm infants (27%) had a correct position, and 1 preterm infant (9%) had a shallow position. Five preterm infants (45%) experienced cardiac tamponade, among whom 4 underwent pericardiocentesis. Seven preterm infants were given conservative medical treatment. Among the 11 children, 2 (18%) died and 9 (82%) improved. CONCLUSIONS Pericardial effusion caused by central venous catheterization mostly occurs in the early stage of catheterization and has critical clinical manifestations. Pericardiocentesis is required for cardiac tamponade, and early diagnosis and intervention can effectively improve prognosis.
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Affiliation(s)
- 雅慧 张
- />北京大学第三医院儿科, 北京 100191Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - 云峰 刘
- />北京大学第三医院儿科, 北京 100191Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - 笑梅 童
- />北京大学第三医院儿科, 北京 100191Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - 丹芳 陆
- />北京大学第三医院儿科, 北京 100191Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - 诗 石
- />北京大学第三医院儿科, 北京 100191Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
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22
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Cevik M, Erek E. Hickman catheter-induced cardiac tamponade-related cardiac perforation management by mediastinotomy in children and a review of the literature. Trauma Case Rep 2021; 32:100436. [PMID: 33665325 PMCID: PMC7907533 DOI: 10.1016/j.tcr.2021.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Hickman catheter placement rarely causes cardiac tamponade due to cardiac perforation in children. Cardiac perforation can be managed with timely perceive and appropriate approach. We present a case of the cardiac perforation related to Hickman catheter insertion in a 7-year-old girl and a review of the supporting literature. Case report The patient had previous history of Thalassemia and admitted to hospital for Hickman catheter placement for bone marrow transplantation. The catheter was placed in the right internal jugular vein by ultrasonography. During the postoperative period she had hypoxia, hypotension and tachycardia. The patient underwent an emergency surgery and there was a small perforation between vena cava superior and right atrium. That wound was managed by mediastinotomy. The patient was discharge on the 8th postoperative day. Conclusion Cardiac perforation is one of the rare and unexpected complications of Hickman catheter placement. Unfortunately, the complication may cause significant mortality. The prompt diagnosis and early intervention provides satisfactory results.
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Affiliation(s)
- Muazez Cevik
- Acibadem University, Faculty of Medicine, Department of Pediatric Surgery, Istanbul, Turkey
| | - Ersin Erek
- Acibadem University, Faculty of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
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23
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Cahill AM, Escobar F, Acord MR. Central venous catheter fracture leading to TPN extravasation and abdominal compartment syndrome diagnosed with bedside contrast-enhanced ultrasound. Pediatr Radiol 2021; 51:307-310. [PMID: 32889586 DOI: 10.1007/s00247-020-04825-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
Central venous lines may require contrast injection under fluoroscopy to evaluate for dysfunction such as occlusion, fibrin sheath development or catheter fracture. Rarely, some patients may be too ill to travel to the interventional radiology suite for this examination. We present a case utilizing contrast-enhanced ultrasound (CEUS) at the bedside to assess catheter integrity in a critically ill infant with a large intra-abdominal fluid collection. CEUS demonstrated extravasation into the collection, confirming catheter fracture and prompting immediate cessation of line use and recommendation for exchange. This case shows the utility of CEUS to evaluate central venous access devices in children who are unable to travel to interventional radiology for a standard contrast injection.
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Affiliation(s)
- Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Fernando Escobar
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael R Acord
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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24
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Mavis SC, Reis CA, Klinkner DB, Stetson RC, Potter DD, Brumbaugh JE. Extravascular migration of a peripherally inserted central catheter into the retroperitoneum in a preterm infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Abstract
Cardiac ultrasound is increasingly used to guide hemodynamic decision making in the neonatal intensive care unit (NICU). This article focuses on likely future progress in training, accreditation, digital connectivity, miniaturization, and modality development. Many documents have been published internationally to guide cardiac ultrasound training, accreditation, and implementation in the NICU, but challenges remain in providing assessments of hemodynamic status without risking missed structural diagnoses. Advances in simulation training and digital connectivity provide an opportunity to standardize approaches across institutions and continents. Development of machine learning and ultrasound modalities in turn provide huge scope for improving robustness and completeness of assessment.
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Affiliation(s)
- Alan Groves
- Division of Newborn Medicine, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue, New York, NY 10029, USA.
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26
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Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol 2020; 40:581-588. [PMID: 31911643 DOI: 10.1038/s41372-019-0575-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine factors associated with nonelective PICC removal and complications. STUDY DESIGN Overall, 1234 PICCs were placed in 918 hospitalized infants <45 weeks postmenstrual age. Outcomes studied include nonelective PICC removal (removal prior to completion of therapy) and line complications. Univariate and multivariate mixed-effects logistic regression analyses were conducted to evaluate the associations between potential predictor variables and clinical outcomes RESULTS: Nonelective PICC removal occurred in 28.4% and complications in 34.4% of infants. Nonelective removal (p < 0.001) and complications (p = 0.006) occurred more often with upper than lower extremity PICCs. Malposition in the first 72 h (p = 0.0009) and over time (p = 0.0003) were more common in upper extremity PICCS; however, upper extremity PICCs were associated with a decreased incidence of phlebitis, edema, and perfusion changes (p = 0.03). CONCLUSIONS Approximately one-third of PICCs were associated with complications. When feasible, lower extremity PICCs should be placed as they may be associated with fewer complications.
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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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28
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Yu X, Wang X, Fan L, Cao N, Yang F, Li J, Jiang H. Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study. Front Pediatr 2020; 8:570978. [PMID: 33134231 PMCID: PMC7562827 DOI: 10.3389/fped.2020.570978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position. Objective: To investigate the causes and preventive measures of ECC-related PE in neonates. Methods: This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated. Results: ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero (P < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site (P < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without (P < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively. Conclusion: ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiujun Li
- Department of Pediatrics, Plateau Medical Research Center of China Medical University, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Jiang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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29
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Badheka A, Bloxham J, Schmitz A, Freyenberger B, Wang T, Rampa S, Turi J, Allareddy V, Auslender M, Allareddy V. Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience. BMJ Open 2019; 9:e026031. [PMID: 31444177 PMCID: PMC6707696 DOI: 10.1136/bmjopen-2018-026031] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme. DESIGN Retrospective cohort study. SETTING Single-centre, large quaternary children's hospital. PARTICIPANTS Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI. CONCLUSIONS The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.
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Affiliation(s)
- Aditya Badheka
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | - Jodi Bloxham
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | - April Schmitz
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | | | - Tong Wang
- Management Sciences, University of Iowa Henry B Tippie College of Business, Iowa City, Lowa, USA
| | - Sankeerth Rampa
- Health Care Administration, Rhode Island College, Providence, Rhode Island, USA
| | - Jennifer Turi
- Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | | | - Marcelo Auslender
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
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Back to Fundamentals: Radiographic Evaluation of Thoracic Lines and Tubes in Children. AJR Am J Roentgenol 2019; 212:988-996. [PMID: 30779658 DOI: 10.2214/ajr.18.20704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to provide an up-to-date review of the radiographic appearance of the most commonly used thoracic lines and tubes in pediatric patients in daily clinical practice. CONCLUSION. Thoracic support lines and tubes are frequently used in children receiving hospital care. Evaluation of these devices is a fundamental skill in radiology. Many different devices are currently used, and new devices are regularly introduced. It is essential for radiologists to maintain a clear understanding of all devices currently in use.
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Chiumento RV, Anderson JF, Bartle DG. Total parenteral nutrition in the pleural space. BMJ Case Rep 2018; 2018:bcr-2018-224561. [PMID: 30266738 DOI: 10.1136/bcr-2018-224561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | | | - David George Bartle
- Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Barreiros LL, Andrade FMD, Torres RA, Magalhães LVB, Farnetano BDS, Fiorelli RKA. Cardiac tamponade by peripherally inserted central catheter in preterm infants: role of bedside ultrasonography and therapeutic approach. ACTA ACUST UNITED AC 2018; 45:e1818. [PMID: 30020322 DOI: 10.1590/0100-6991e-20181818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to determine the incidence of pericardial effusion with cardiac tamponade in preterm infants in a pediatric intensive care unit, with emphasis on the relationship between pericardial effusion and peripherally inserted central catheter, and to evaluate the role of bedside ultrasound in approaching these cases. METHODS we conducted a retrospective analysis of patients admitted to a pediatric intensive care unit between July 2014 and December 2016, who presented pericardial effusion with hemodynamic repercussion, evaluated by ultrasonography. RESULTS we studied 426 patients admitted to the five beds of the neonatal unit. In the period, there were 285 bedside ultrasound exams. We found six cases of pericardial effusion, four of which with obstructive shock and need for pericardial drainage. There was no procedure-related mortality, and all patients evolved with hemodynamic improvement after the procedure. The incidence of pericardial effusion was 2.4 cases per year. CONCLUSION the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.
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Affiliation(s)
- Livia Lopes Barreiros
- Universidade de Vassouras, Mestrado Profissional em Ciências Aplicadas em Saúde, Vassouras, RJ, Brasil.,Hospital Santa Isabel, Unidade de Terapia Intensiva Neonatal, Ubá, MG, Brasil
| | - Filipe Moreira de Andrade
- Universidade de Vassouras, Mestrado Profissional em Ciências Aplicadas em Saúde, Vassouras, RJ, Brasil.,Hospital Santa Isabel, Unidade de Terapia Intensiva Neonatal, Ubá, MG, Brasil.,Universidade Federal de Viçosa, Departamento de Enfermagem e Medicina, Viçosa, MG, Brasil
| | - Ronaldo Afonso Torres
- Hospital Santa Isabel, Unidade de Terapia Intensiva Neonatal, Ubá, MG, Brasil.,Universidade Federal de Viçosa, Departamento de Enfermagem e Medicina, Viçosa, MG, Brasil
| | | | - Bruno Dos Santos Farnetano
- Hospital Santa Isabel, Unidade de Terapia Intensiva Neonatal, Ubá, MG, Brasil.,Universidade Federal de Viçosa, Departamento de Enfermagem e Medicina, Viçosa, MG, Brasil
| | - Rossano Kepler Alvim Fiorelli
- Universidade de Vassouras, Mestrado Profissional em Ciências Aplicadas em Saúde, Vassouras, RJ, Brasil.,Universidade Federal do Estado do Rio de Janeiro, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil
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