Bilateral consolidation of the lungs in a preterm infant: an unusual central venous catheter complication

Abstract

We describe a case of bilateral parenchymal consolidation with sudden respiratory distress in a preterm baby as a complication of peripherally inserted central catheter (PICC) dislocation. The X-rays showed bilateral pulmonary consolidation with the catheter tip initially located in the right, and later in the left pulmonary artery. The catheter was withdrawn. As soon as the catheter was repositioned all clinical signs and symptoms disappeared. Neonatologists should consider the possibility of dramatic respiratory distress deriving from PICC dislocation. Careful tip catheter placement and conscientious monitoring may reduce morbidity.

Massive pleural effusion on the contralateral side of a venous peripherally inserted central catheter

“…Pignotti et al described as a PICC complication a case of bilateral pulmonary consolidation with the catheter tip initially located in the right, and later in the left pulmonary artery, with acute respiratory distress in a preterm baby . In the present case, the tip of the PICC was also misplaced through the right heart chambers and then into the left pulmonary artery, eventually inducing a left pleural effusion on the contralateral side of the PICC insertion.…”

An unending supply of ‘unusual’ complications from central venous catheters

“…It is difficult to provide an adequate mechanistic explanation for either of the cases reported by Pignotti et al . (3, 4). In one case, there was upper lobe consolidation that was attributed to a 23‐gauge PICC that migrated to first the right and then the left main pulmonary artery in an 850 g neonate (4).…”

“…(3, 4). In one case, there was upper lobe consolidation that was attributed to a 23‐gauge PICC that migrated to first the right and then the left main pulmonary artery in an 850 g neonate (4). It was assumed (rather than shown) that perforation did not occur and that the parenchymal lung disease arose from the combined effects of the misplaced catheter and the irritant hyperosmolar fluid.…”

“…Despite this enormous collective experience, new or unusual complications continue to be reported and five more cases, all neonates, have recently been published in Pediatric Anesthesia. Two were perforations (1, 2), one had pleural and pericardial effusion without evidence of perforation (3), one had pulmonary infiltrates that were attributed to a peripherally inserted central catheter (PICC) that migrated to the main pulmonary arteries (4) and one was pulmonary embolization of a PICC fragment (2). These examples provide a reminder of uncommon clinical events and add to the current controversy regarding the safety of CVCs in neonates and infants (5–7).…”

Author's reply

“…As Dr Nadroo has demonstrated (2), it may change in a many situations during routine care of the baby as well as with the weight lost during the first days of life (4), and, perhaps, also due to flushing into the vein. In one other case (5), we described a catheter fluctuation from the right to the left main pulmonary arteries. We think that serial X‐rays, as suggested by Nadroo et al .…”