Central Venous Catheter-Associated Pericardial Tamponade in a 6-Day Old: A Case Report

Abstract

Introduction. Pericardial effusion (PCE) and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts. Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space. Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE.

Pericardial effusion and cardiac tamponade following percutaneously inserted central line insertion in an extremely low-birth-weight baby: Case report and successful management

“…The cause for such effusions is not clear, but various theories have been suggested based on clinical findings. [ 6 ] The authors have attributed the damage to the termination site and the angle at which the catheter lies within the heart, repeated contact of the catheter tip with the cardiac wall may result in endothelial injury and thrombus formation, and this endothelial injury and adherence of the tip to the cardiac wall due to the thrombus may eventually lead to diffusion of fluid in the pericardial space. There are case reports of cardiac tamponade even in babies with correctly positioned catheter tip.…”

Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

“…On the other hand, mechanism of pericardial effusion due to the catheter is poorly understood [ 1 , 4 ]. In neonates, it has been hypothesized that it is likely due to myocardial weakness and areas, which are at increased risk of perforation [ 4 ].…”

“…On the other hand, mechanism of pericardial effusion due to the catheter is poorly understood [ 1 , 4 ]. In neonates, it has been hypothesized that it is likely due to myocardial weakness and areas, which are at increased risk of perforation [ 4 ]. For catheter-induced injury, movements of the catheter tip, angle of insertion, movement of the cardiac chambers, and direct trauma have all been postulated to be responsible for cardiac perforation [ 3 ].…”

“…Due to the fatal nature of the illness, it should be suspected in any patient who deteriorates soon after the CVC insertion [ 3 ]. It is more common in neonates and pediatric age group with overall adult rates less than 1% [ 1 , 4 ]. Although right atrium and right ventricle are commonly affected resulting in cardiac tamponade, it could also be due to superior vena cava perforation [ 3 ].…”

Umbilical catheter placement and pericardial effusion in neonates: The US national database

“…Several case reports associated iatrogenic pericardial effusion in neonates with insertion of central venous or arterial catheters [7][8][9]. Other causes of PE include thyroid dysfunction, cardiac and pericardial tumors, multiple congenital anomalies, congenital or acquired viral infections, postoperative and idiopathic [10,11].…”