Acute Cardiorespiratory Deterioration in a Preterm Infant

Kaluarachchi, Dinushan C.; Klein, Jonathan M.

doi:10.1542/hpeds.2015-0011

Cited by 1 publication

(1 citation statement)

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“…Whereas the ideal PICC position, when needed, is controversial, the tip of the PICC should be located outside the pericardial reflection line, meaning at a level above T2 on the chest radiograph. This was supported by Nowlen in his case series, where the catheter tip was last reported within the pericardial reflection in 92% of cases (27). Routine chest imaging following neonatal PICC insertion should be obtained to identify the location of the tip.…”

Section: Discussionmentioning

confidence: 83%

Tamponade and massive pleural effusions secondary to peripherally inserted central catheter in neonates–A complication to be aware of

Zareef

Anka²,

Hatab³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundPeripherally 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.ObjectiveThis 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 designRetrospective 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.ResultsFour neonates developed significant life-threatening effusions. Urgent pericardiocentesis and chest tube placement were required in two and one patients, respectively. No fatalities were encountered.ConclusionThe 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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Section: Discussionmentioning

confidence: 83%