Peripherally inserted central catheter causing life‐threatening cardiac tamponade

Abstract

We report a 60-yr-old female who had a peripherally inserted central catheter (PICC) for parenteral nutrition (TPN). Insertion was uneventful although the line was seen to extend into the right ventricle. The line was re-positioned but soon after commencing TPN she collapsed. Computerised tomography pulmonary angiography (CTPA) demonstrated a pericardial effusion with a high fat content. Pericardiocentesis revealed fluid with a high triglyceride content and confirmed pericardial placement of ther tip of the catheter. The patient subsequently made an uneventful recovery. We could only find one other case in the literature of pericardial tamponade after PICC placement in an adult. The exact anatomical course of this line remains unclear despite careful review of radiological imaging. We discuss methods to gauge appropriate line length, possible signs on chest radiography and the immediate management of pericardial tamponade. Resuscitation via a malpositioned line may prove catastrophic; if doubt exsists the line should not be used.

Neonatal cardiac tamponade, a life-threatening complication secondary to peripherally inserted central catheter: a case report

“…It has also been reported that in addition to catheter displacement, other factors, such as the material, length, and size of the catheter, duration of parenteral nutrition, osmolarity, and composition of the infused fluids may severely affect and worsen complications and outcomes related to cardiac tamponade. For example, it was reported in one study that pericardial presence of high-potassium infused fluid resulted in electrocardiogram alterations showing a pattern of hyperkalemia instead of a pattern of cardiac tamponade [1, 9,12]. Another study also showed that tamponade was frequently observed in cases with PICC inserted through aperipheral vein compared to a central vein [4].…”

“…Of the above complications, tamponade is a rare but fatal condition that occurs following catheter dislocation and pericardial perforation [8]. Cardiac tamponade is responsible for 47-100% of the mortality rate [9].…”