Massive liver mass and parenteral nutrition extravasation secondary to umbilical venous catheter complications

Yeh, Joanna; Vargas, Jorge; Wozniak, Laura J.; Smith, Jeffrey B.; Boechat, M. Ines; Touma, Marlin

doi:10.4103/2249-4847.140404

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…Although UVC was correctly inserted on admission and position was verified by radiology, yet significant TPN extravasation in hepatic parenchyma occurred on day 4. The onset of diagnosis in our patient was earlier than many reported cases of UVC extravasation that manifested usually beyond the first week of life [2][3][4][5]. The prompt diagnosis was augmented by the bed side ultrasonography as a simple noninvasive diagnostic tool that can be operated easily in NICU.…”

Section: Discussionmentioning

confidence: 62%

A Preterm Infant With Mild Abdominal Distension and Rising C-Reactive Protein

Alshafei

Ahmed

2019

Int J Clin Pediatr

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Abdominal distension is a common clinical presentation in neonates admitted to neonatal intensive care units (NICUs), especially preterm infants. The underlying causes are multiple and range from simple transient etiologies to life-threatening events with significant morbidities. Neonatal sepsis is the most common diagnosis encountered; however, other differential diagnoses should be thought. Premature neonates are particularly susceptible to abdominal distension because of gut immaturity, relative immune deficiency and frequent exposure to invasive procedures. Herein, we report a preterm infant who developed abdominal distension and hepatomegaly on day 4 of life. This was associated with progressively rising C-reactive protein (CRP) levels and normal abdominal X-ray. Bed side abdominal ultrasonography revealed the diagnosis.

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Section: Discussionmentioning

confidence: 62%

A Preterm Infant With Mild Abdominal Distension and Rising C-Reactive Protein

Alshafei

Ahmed

2019

Int J Clin Pediatr

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“…The appropriate position of UVC is just above or at the level of the diaphragm (T7-T9) between the inferior vena cava and the right atrium after passage through the portal system and ductus venosus. [7][8][9][10] There is a concern of the UVC being positioned in the liver when it is below the diaphragm (T10 or below). The position, although borderline in this case (T9), was accepted following radiology opinion.…”

Section: Discussionmentioning

confidence: 99%

“…These include blood-borne catheter-related infection, blood loss during catheterisation or catheter detachment, air embolism, catheter tip migration, thromboembolic complications, cardiac tamponade, disorders of cardiac rhythm and pericardial or pleural effusion. [4][5][6][7][8][9] Although thought to be uncommon, complications such as air in the portal system (20%), portal venous thrombosis (6%) and hepatic lesions (7%) have been noted on ultrasound. 8 Improper position of UVCs can allow leakage of hyperosmolar parenteral nutrition into the liver tissue, with significant damage to the liver parenchyma, hepatic necrosis and ascites.…”

Section: Introductionmentioning

confidence: 99%

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

Majid¹,

Barrett²,

Meyer³

2021

RRN

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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.

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“…Umbilical vein catheterisation (UVC) is a common procedure performed in neonatal intensive care unit (NICU) [1]. UVCs allow quick access for intravenous fluid and drug administration, blood products and parenteral nutrition to acutely ill neonates; besides these benefits, there are complications associated with their use [2][3][4]. One of uncommon complication is extravasation of the fluids due to misplacement of the catheter.…”

Section: Introductionmentioning

confidence: 99%