Acute Mediastinitis Due to Extravasation of Parenteral Nutritional Formula via a Central Venous Catheter

Marín, Miguel Ruiz; Rodríguez, Marcela A.; Buleje, Jorge Alejandro Benavides; Valverde, Francisco Miguel González; Martínez, Marcelino Méndez; Pérez, Patricia Pastor; Ruiz, María Vicente; Rodríguez, Ana Ruiz; Sales, Alejandro Puerta; Rodríguez, Pedro Marín; Blázquez, Antonio

doi:10.4037/ajcc2012854

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…In the previous study, the symptoms related to vascular erosions caused by a CVC appears 2.5-3.6 days after insertion of the CVC [ 2 , 9 ]. The most common signs and symptoms related to vascular erosions and mediastinitis are dyspnea, chest pain, neck swelling, fever, and dilated superficial veins [ 10 ]. But these signs and symptoms are not specific, therefore a diagnosis of mediastinis according to vascular erosion can be delayed and misdiagnosis can be made.…”

Section: Discussionmentioning

confidence: 99%

Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

Byeon

Kim

Yoon

et al. 2015

J Dent Anesth Pain Med

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Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

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Section: Discussionmentioning

confidence: 99%

Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

Byeon

Kim

Yoon

et al. 2015

J Dent Anesth Pain Med

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“…Left sided catheters may also be more likely to result in vessel rupture. When a left sided catheter is not inserted far enough, the catheter tip is more likely to be positioned at a perpendicular angle to the vessel wall, resulting in a compromise of structural wall integrity (16) PICC's are being increasingly used in critically ill patients. The insertion site is perceived to be of lower risk as it minimises the risk of pneumothorax, haemothorax and can be used with greater degree of safety in coagulopathic patients.…”

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confidence: 99%

Mediastinal Complications Secondary to Extravasated Peripherally Inserted Central Venous Catheter: A Case Report

Licina¹,

Gupta²,

Silvers³

2019

Preprint

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Background Peripherally inserted central venous catheters (PICC) are increasingly used in critically ill patients for the ease of access, long-term medication and total parenteral nutrition administration. There is a perception of equivalent utility of PICC lines with a lower incidence of complications as compared to central venous lines. Despite the perception of relative safety, complications can occur. Case Presentation We describe a case of a patient who developed increasing signs and symptoms of sepsis, shortness of breath, and hypoxemia following combined liver and renal transplant 11 days following the initial procedure. Computerised tomography of neck and chest demonstrated pneumo-mediastinum, extensive retropharyngeal and subcutaneous emphysema. The patient returned to theatre on post-operative day 12, for flexible bronchoscopy, video-assisted thoracoscopic surgery and mediastinal washout. Following a further clinical and imaging review, an un-anticipated diagnosis of extravasated peripherally inserted central venous cannula (PICC) as a causative factor of multiple pathologies was made. PICC line was removed. Mediastinal and thoracoscopic examinations were performed and drains inserted. The patient returned to the intensive care unit for ongoing supportive management, with a gradual improvement of sepsis and resolution of mediastinal air distribution. Conclusions Peripherally inserted central venous catheters have an ease of insertion and appreciable favourable health economic outcomes. Recent reviews however have demonstrated an increased risk of catheter tip malposition, in addition to increased risk of thrombosis as compared to central venous lines. Due to the characteristic mobility of these devices, mediastinal and intra-thoracic extravasation of these catheters can occur with consequent severe morbidity. Awareness of the tip position and accompanying clinical and radiological enquiry, must be performed both in the differential diagnosis of chest pathology and prior to use of PICC lines in critically ill patients.

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A case of mediastinitis caused by peripherally inserted central catheter

Matsuoka

Matsubara

Kunimitsu

et al. 2022

The Journal of the Japanese Association for Chest Surgery

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Acute Mediastinitis Due to Extravasation of Parenteral Nutritional Formula via a Central Venous Catheter

Cited by 3 publications

References 4 publications

Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

Mediastinal Complications Secondary to Extravasated Peripherally Inserted Central Venous Catheter: A Case Report

A case of mediastinitis caused by peripherally inserted central catheter

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