Pericardial Effusion/Cardiac Tamponade Induced by Peripherally Inserted Central Catheters in Very Low Birth Weight Infants: A Case Report and Literature Review

Abstract

Background: Although pericardial effusion/cardiac tamponade (PCE/CT) is a rare complication of peripherally inserted central catheters (PICCs), with an incidence of 0. 07-2%, it is associated with high mortality and is often life threatening. We sought to improve understanding of PICC-induced PCE/CT among pediatricians. Case presentation:The clinical data of PICC-associated PCE/CT in a very low birth weight (VLBW) infant were summarized, and the relevant literature was also reviewed. Conclusions:In VLBW infants with a PICC, if unstable respiratory circulatory system states are observed that cannot be explained, such as tachycardia, bradycardia, apnea, hypotension, and metabolic acidosis, PICC-induced PCE/CT should be considered. Early diagnosis and pericardial puncture are key to saving infants' lives.

Peripherally inserted central catheter related pericardial effusion/cardiac tamponade in neonates: Analysis of two cases and literature review

“…Nadroo et al found that soft tissue around the catheter would be squeezed during adduction of the shoulder joint or flexion of the elbow, and the venous catheter would displace from the heart; whereas concurrent shoulder joint adduction and elbow flexion would result in its retraction towards the heart. [3] Therefore, maintaining arm adduction and elbow flexion during X-ray positioning can effectively reduce the risk of pericardial effusion caused by PICC displacement into the right atrium due to arm movement, [10] and the exposed end of the PICC should be securely affixed with adhesive tape to minimize catheter migration. [4,9] To ensure accurate positioning of the catheter tip, X-ray or cardiovascular ultrasonography should be performed at least twice a week.…”

“…[9] There were also reports of successful rescue by either repositioning the catheter tip away from the right atrium or direct drainage of the effusion via PICC. [10] However, once echocardiography reveals cardiac chamber compression and deformation, restricted diastole and systole, and reduced cardiac output, prompt pericardiocentesis is necessary. The subxiphoid percutaneous approach is a safer and more reliable option.…”

“…As shown in Table 1, from the beginning of the 21 st century, including our 2 cases reported herein, a total of 35 cases of PICC-related neonatal pericardial effusion/cardiac tamponade have been reported in China and abroad, [3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18] with an average GA of (29.7 ± 3.7) weeks and an average BW of (1243.3 ± 517.3) g. Normally, there are about 5 ml of pericardial fluid in the pericardial cavity of newborns, and a small amount of fluid serves as lubrication to reduce friction during cardiac contraction. [8] However, when a significant accumulation of fluid occurs within the pericardium, the pressure within the pericardial cavity increases, thereby limiting cardiac diastolic function correspondingly.…”

“…It has been demonstrated that the determinants of PICC-related pericardial effusion encompass gestational age, body weight, catheter insertion site, catheter tip position, catheter bending, angulation, catheter migration, and hypertonic fluid infusion, etc. [10,22] A descriptive statistical analysis found preterm infants (GA < 37 weeks)/low birth weight (BW < 2500 g) infants were accounted for the majority of the 35 cases reported (Fig. 3).…”

A nurse-inserted peripherally inserted central catheter program in general pediatrics: a single-center experience

“…A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava allows for middle to long-term intravenous therapy, blood sampling, and reductions in repeated intravenous catheterizations [1,2]. Though PICC insertion is a relatively convenient and effective technique, it can cause life-threatening complications such as catheterrelated bloodstream infection [3,4] and pericardial tamponade [5][6][7][8].…”