Central Venous Catheter Tip in the Right Atrium: A Risk Factor for Neonatal Cardiac Tamponade

Darling, Jonathan C.; Newell, S J; Mohamdee, Omar; Uzun, Orhan; Cullinane, Catherine; Dear, P. R. F.

doi:10.1038/sj.jp.7210541

Cited by 80 publications

(57 citation statements)

References 17 publications

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“…Notably, approximately a quarter of the cases were first diagnosed during post-mortem at autopsy [1]. The mortality is very high (45-65%) [1,3] and those resuscitated successfully improved only after emergency pericardiocentesis was performed. Analysis of the aspirated liquid usually reflected the composition of the parenteral nutrition.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to catheter-associated infections and thrombosis, which increase over time, pericardial effusion may occur directly after the insertion of catheters, or later, with a peak at three days following catheter insertion [4]. The malposition of central catheters is considered to be the main risk factor for pericardial effusion, particularly if the catheter tip projects into the right atrium or shows angulation [1,3,8]. Umbilical catheters should not be used if the blood does not return freely upon insertion.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of infants with reported pericardial effusion became acutely symptomatic due to cardiac tamponade and deteriorated rapidly with signs of respiratory distress, cyanosis, tachycardia or bradycardia, mottled skin, and arterial hypotension, finally leading to cardiopulmonary arrest not responsive to standard interventions [1,3]. Notably, approximately a quarter of the cases were first diagnosed during post-mortem at autopsy [1].…”

Section: Discussionmentioning

confidence: 99%

“…UVC=umbilical venous catheter; UAC=umbilical arterial catheter Fig. 3 Echocardiography demonstrating large pericardial effusion (white arrows) on day three associated cardiac tamponade, guidelines have been published aimed at reducing the risk of cardiac perforation [3,4,6].…”

Section: Discussionmentioning

confidence: 99%

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Cardiomegaly in a premature neonate after venous umbilical catheterization

et al. 2008

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Umbilical venous catheters allow rapid central access in neonates, but may be associated with various complications. We present a case of a newborn with pericardial effusion following umbilical venous catheterization. An extremely low birth weight infant was intubated for respiratory distress syndrome and had umbilical venous and arterial lines in place. Massive cardiomegaly was noted on the subsequent chest X-ray. Echocardiography revealed a large pericardial effusion without signs of tamponade. After removing the catheter, the effusion gradually resolved. While pericardial effusion is a well-known complication of percutaneous long central lines, only a few case reports have documented sudden cardiovascular compromise associated with umbilical venous catheters. Pericardial effusion may be asymptomatic and should be suspected in infants with central catheters and progressive cardiomegaly. The prompt removal of catheters and, if signs of cardiac tamponade are present, emergency pericardiocentesis may prove to be life-saving.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiomegaly in a premature neonate after venous umbilical catheterization

et al. 2008

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“…74,75 Placement of the catheter in the right atrium can lead to damage of the endocardium inducing either pericardial tamponade and/or the development of intracardiac thrombi. 76,77 The development of intracardiac vegetations secondary to line infections can expose the infant to prolonged infection and dissemination of septic emboli. 76 However, some centers have reported successful placement of CVLs in the right atrium if strict management guidelines are followed.…”

Section: Venous Thrombosismentioning

confidence: 99%

The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed. Case study A full-term male infant born through spontaneous vaginal delivery was admitted to the neonatal intensive care unit (NICU) shortly after birth due to a history of low APGAR scores and respiratory distress requiring mechanical ventilation. The pregnancy was complicated by gestational diabetes treated with glyburide and chorioamnionitis was evident during labor. The patient was started on ampicillin and gentamicin and appropriate fluid resuscitation was initiated. The patient improved over the next few days and was able to be weaned off of ventilator support. The patient had an umbilical arterial catheter (UAC) placed after birth that was removed on day 3 of life.On day 4 of life the patient's legs appeared pale. Physical examination demonstrated cool lower extremities and markedly decreased pulses in the feet. Over the previous 24 h, urine output declined significantly.Ultrasound (US) examination of the heart, major vessels and abdomen demonstrated a large thrombus in the descending aorta with very minimal flow to the renal and iliac arteries. A literature search did not reveal any level I management guidelines for thrombosis in neonatal patients, and consideration is now given to surgical thrombectomy, anticoagulation therapy or fibrinolytic therapy. Incidence of neonatal thromboembolic diseaseAlthough neonates have the highest risk of thromboembolism (TE) in the pediatric population, the incidence of postnatal TE varies due to the types of thromboses that were reported and how aggressively centers screened for thromboses. 1 Data from the three international registries are displayed in Table 1. All three registries observed that thromboses occurred in both term and preterm infants and affected male and female infants equally, other than renal vein thrombosis (RVT) that affected more male neonates. [2][3][4] These registries also demonstrated that approximately 90% of venous thromboses in neonates were associated with central venous catheters (CVLs). [2][3][4] The recurrence rate of TE following symptomatic neonatal events ranges from 3.3 to 7%. 5 The international registries are the first step toward...

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Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates

Ainsworth

Clerihew

McGuire

2004

Cochrane Database of Systematic Reviews

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Data from one small study suggest that the use of percutaneous central venous catheters to deliver parenteral nutrition in newborn infants improves nutrient input. The significance of this in relation to longer-term growth and developmental outcomes is unclear. Another study suggested that the use of percutaneous central venous catheters rather than peripheral cannulae decreases the number of catheters/cannulae needed to deliver the nutrition. We have not found any evidence that percutaneous central venous catheter use increases the risk of adverse events, particularly systemic infection.

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Central Venous Catheter Tip in the Right Atrium: A Risk Factor for Neonatal Cardiac Tamponade

Cited by 80 publications

References 17 publications

Cardiomegaly in a premature neonate after venous umbilical catheterization

Cardiomegaly in a premature neonate after venous umbilical catheterization

The evaluation and management of postnatal thromboses

Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates

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