A misplaced peripherally inserted central catheter presenting as contralateral pleural effusion

Kumar, Jogender; Sudeep, K; Mukhopadhyay, Kanya; Ray, Santanu

doi:10.1136/bcr-2018-224471

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…In summary, a non-central tip position was more likely to result in complications and non-selective ECC removal (6, 13). Limb movement, neck position, forceful flushing, and neonatal growth during insertion and the dwell period may change the tip position of a peripherally inserted central catheter (PICC) line (3,5). Despite best efforts, catheter tips may not start or stay in a central location.…”

Section: Discussionmentioning

confidence: 99%

“…Extravasation of PN into the pleural space can cause serious pleural effusion (PE). ECC-related PE can cause acute respiratory distress and may be life-threatening without timely diagnosis and adequate interventions (1)(2)(3)(4)(5). Early identification and correct treatment are necessary to improve the prognosis of this devastating complication.…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study

Wang

Fan

et al. 2020

Front. Pediatr.

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study

Wang

Fan

et al. 2020

Front. Pediatr.

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“…There have been only a few cases (more in neonates than adults) of TPN-related pleural effusion as a complication after PICC placement. 15,16 In our situation, despite in working order, the PICC could have caused micro-trauma to the smaller subclavian and brachiocephalic veins leading to erosion. 17 In addition, having hyperosmolar fluid such as TPN infused with a pump can lead to breakdown of the endothelium further leading to seepage of TPN into the pleural spaces.…”

Section: Discussionmentioning

confidence: 73%

Total parenteral nutrition pleural effusion after peripherally inserted central venous catheter insertion despite fluoroscopic confirmation

Yang

Lopez

2023

SAGE Open Medical Case Reports

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Peripherally inserted central catheters are frequently used for durable central venous access for nutrition. Depending on the medical and surgical history, there are times when a person’s vasculature has become scarred or stenotic due to multiple previous vascular devices, catheters, or pacemaker/defibrillator leads, that causes placement of a peripherally inserted central catheter challenging. Choosing the correct catheter and approach must be weighed against invasiveness of the procedure as unforeseen complications can arise. When pleural effusions quickly accumulate after placement of a peripherally inserted central catheter despite using confirmatory image guidance, delayed complications must be thought of, and offending medications and catheter should be removed in a timely fashion to avoid further morbidity and mortality.

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“…They took a sitting position, leaned their body forward 45° and extended their shoulder joint to the maximum angle in order to move the tip of the catheter up. 12,13 The authors performed a jet injection of 0.9% Saline and checked the result using the intracavitary electrocardiography method of tip location. [14][15][16][17][18] After the appearance of high-amplitude P waves, chest radiograph showed that the PICC was re-positioned into the vena cava in five cases.…”

Section: Management Of Secondary Malposition Of Picc Into Azygos Veinsmentioning

confidence: 99%

Diagnosis and management of secondary malposition of PICC into the azygos vein

Wang

Zhao

2021

J Vasc Access

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Background: Peripherally inserted central catheter (PICC) has been widely used. The catheter-related complications might occur and the reports of secondary malposition into azygos veins were rare. Methods: This retrospective review summarized the experience in diagnosis and management of secondary malposition of PICC into azygos veins in 25 cases. Results: When the catheter dysfunction occurred in the PICC on the left limb, it was necessary to consider whether there would be malposition into azygos veins after other reasons were excluded. The malposition could be diagnosed by chest lateral radiograph or chest computed tomography. The secondary malposition into azygos veins was resolved by repositioning or withdrawing the PICC. After re-inserting the catheter, it should be closely monitored whether the malposition occurred again. Intracavitary electrocardiogram positioning technology was used to confirm the catheter tip position before using corrosive drug. After the catheters withdrawn from the azygos veins, close attention should be paid to the property and concentration of the infusion drug strictly and the complications such as blockage and re-malposition. No serious complications such as infection, thrombosis and extravasation occurred in this group of patients after treatment. Conclusions: The results of our study suggested that the right limb is recommended for PICC catheterization in order to avoid secondary malposition into azygos veins and the malposition into azygos veins should be dealt with in time.

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A misplaced peripherally inserted central catheter presenting as contralateral pleural effusion

Cited by 7 publications

References 10 publications

Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study

Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study

Total parenteral nutrition pleural effusion after peripherally inserted central venous catheter insertion despite fluoroscopic confirmation

Diagnosis and management of secondary malposition of PICC into the azygos vein

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