Acute Management of Intraperitoneal Extravasation of Total Parenteral Nutrition (TPN) in a Very Preterm Infant: Case Report and Literature Review

Abstract

Purpose: Use of umbilical catheters is standard practice in neonatal intensive care units due to ease of insertion and provision of longer-term vascular access. Complications of umbilical venous catheters, including extravasation of total parenteral nutrition (TPN) fluid, are rare but when they occur have high mortality and morbidity. Umbilical venous catheters tend to migrate over time, and their position may change, so a high index of suspicion should be maintained. Our aim was to describe a case with extravasation of parenteral nutrition fluid and review the medical literature. Patients and Methods: Case report. Results: The infant was born at 28 weeks' gestation (1510 g). On day 6 he presented with nonspecific abdominal distension, hypotension, respiratory deterioration, metabolic acidosis and was critically ill. Radiological and ultrasound findings were consistent with TPN ascites due to a malpositioned umbilical venous catheter. Bedside paracentesis without laparotomy was carried out. Despite a stormy course, the infant recovered and the liver injury with conjugated hyperbilirubinemia improved over a period of several months. Conclusion: Emergency bedside ultrasound and paracentesis with catheter removal may be lifesaving and avoid laparotomy in an already critically unwell preterm infant.

Point‐of‐care ultrasound aided diagnosis and management of peritoneal parenteral nutrition extravasation in a preterm baby: A case report

“…On review of previously documented US findings of UVC extravasation, a case series including three patients with described appearance of collapsed bowel loops, free fluid/ascites, and echogenic separate debris suggestive of hemorrhage fluid and an echogenic focus in the left lobe of the liver 5 . Additional literature describes the presence of intrahepatic collections in case reports reviewing UVC extravasation, which was not identified in our case 6–8 …”

“…5 Additional literature describes the presence of intrahepatic collections in case reports reviewing UVC extravasation, which was not identified in our case. [6][7][8] In our literature review, we did not find any reports that focus on describing US findings when extravasation occurs outside the hepatic capsule, predominantly affecting the peritoneum. As described in the case review, we appreciated echoic bowels which were concealed and not floating out into the ascites.…”

“… 5 Additional literature describes the presence of intrahepatic collections in case reports reviewing UVC extravasation, which was not identified in our case. 6 , 7 , 8 …”

Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge

“…Due to the potential for both benefit and harm associated with UVC removal timing, they suggested the need for a pragmatic randomized controlled trial comparing early planned removal with expectant management to provide more conclusive insights into this matter [5]. The increased risk of malpositioning, infection, and hepatic extravasation underscores the importance of regularly reassessing the necessity of UVCs and considering alternative central access methods if prolonged use is anticipated [2,[6][7][8][9][10][11][12][13]. Peripherally inserted central catheters (PICCs) emerge as a viable alternative, as demonstrated in a study conducted by Lloreda-García JM and colleagues [14].…”