Bilateral pleural effusion and pneumomediastinum: rare complication resulting from punctured left subclavian vein following insertion of PICC line for total parenteral nutrition

Abstract

This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.

Misplacement of a left internal jugular vein puncture into the subclavian vein in a patient undergoing ECMO: a case report

“…A PICC can be used if the patient is hemodynamically stable and requires protracted intravenous fluid support. 12 If the left internal jugular vein catheter is required for specific reasons, imaging should be performed on the patient's local and adjacent vessels prior to the procedure. The bevel of the puncture needle should be directed proximally during the procedure.…”

Chylothorax and mediastinal haematoma by central venous catheter post-duodenal ulcer and pyloroplasty surgery: a case report

“…A case of bilateral pleural effusion and pneumomediastinum resulting from left subclavian vein puncture during peripherally inserted CVC line placement has been reported. 8 The patient presented with hypoxaemic respiratory failure. Pulmonary CT angiogram was performed to look for pulmonary embolism, revealing the vascular injury.…”