Extravascular collection of fluid around the vertebra resulting from malpositioning of a peripherally inserted central venous catheter in extremely low birth weight infants

Mitsufuji, Nobuto; Matsuo, Kikuo; Kakita, Shizuyo; Ikuta, Haruyasu

doi:10.1515/jpm.2002.051

Cited by 14 publications

(5 citation statements)

References 3 publications

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“…A high index of suspicion is needed to alert a physician to this rare type of complication [6]. Anteroposterior and lateral view roentgenograms are a useful means of diagnosing the malpositioning of CVC in the inferior vena cava [9,7]. In our case, the infant had a postsurgical anatomic variation.…”

Section: Discussionmentioning

confidence: 82%

The mysterious pleural effusion

Simão¹,

Neves²,

Neves³

et al. 2014

Annals of Pediatric Surgery

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Central venous catheter placement for long-term total parenteral nutrition is a well-established practice. Considering the number of placed lines, serious complications are rare but may be life threatening. We report the case of a 6-month-old infant on total parenteral nutrition since neonatal period, as a consequence of severe intestinal insufficiency secondary to extensive intestinal resection for necrotizing enterocolitis. The child was admitted to the ICU with respiratory failure due to bilateral milky pleural effusion 17 days after placement of a left internal saphenous line. Pleural effusion analysis was suggestive of chylothorax, with high triglyceride (722 mg/dl) and low cholesterol (< 20 mg/dl). Persistence of pleural effusion, despite adequate treatment, drew attention to other diagnostic hypothesis. Considering that parenteral nutrition solution used is cholesterol free and the child complained of pain when administered bolus through the catheter, the hypothesis of misplacement of the central venous catheter became more likely. Computed tomography scan after contrast administration through the catheter revealed its presence in the epidural space and the ascending route reaching the pleural space. When parenteral nutrition was stopped, the pleural effusion resolved. At the present time, with 2 years of follow-up, the child does not have any complication of this event. This is, to our knowledge, the first reported case of an infant developing bilateral pleural effusion secondary to misplacement of a left internal saphenous catheter. Ann Computed tomography scan. (a) Lateral left deviation at L4-L5 level of catheter route. (b) Contrast in epidural space. (c) Contrast passing through the intervertebral foramen. (d) Contrast in pleural space. (e) Contrast in epidural space and vertebral plexus surrounding the vertebral body of a low thoracic vertebra. Arrow indicates signaling contrast. Pleural effusion: a saphenous CVC complication Simã o et al. 85

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Section: Discussionmentioning

confidence: 82%

The mysterious pleural effusion

Simão¹,

Neves²,

Neves³

et al. 2014

Annals of Pediatric Surgery

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“…PICC malposition in the adjacent place of the vertebral body (Mitsufuji et al . ), vertebral vein (Ling et al . ), azygos vein (Haygood et al .…”

Section: Resultsmentioning

confidence: 99%

Repositioning techniques of malpositioned peripherally inserted central catheters

Jin

Chen

Zhao

et al. 2012

Journal of Clinical Nursing

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“…The lower limb venous vessels have relatively thick inner diameters, straighter catheterization paths, and a high success rate of one‐time puncture, which can reduce the damage to the vascular endothelium and reduce the risk of infection (Cheng et al, 2016; Schwengel et al, 2004). The blockage of the PICC catheter is related to the slenderness of its own pipeline, the nature of the input liquid, whether the flushing and sealing tube is standardized, etc (Mitsufuji et al, 2002; Xia et al, 2009). In this study, there is no difference in the incidence of the blockage of the upper and lower limb veins.…”

Section: Discussionmentioning

confidence: 99%

Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta‐analysis of randomized controlled trials

Zhao,

Liu,

et al. 2023

Specialist Pediatric Nursing

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AimPeripherally inserted central catheter (PICC) is an important treatment for the drug and nutrition administration in neonates. We aimed to evaluate the effects and safety of PICC placement through upper versus lower limb vein in neonates, to provide insights into the clinical PICC nursing care.DesignA meta‐analysis.MethodsWe searched the Cochrane Library, Web of Science, PubMed, Science Direct, China national knowledge infrastructure, Wanfang Data Knowledge Service Platform, China Weipu Database, China Biomedical Literature Database for published randomized controlled trials (RCTs) on the placement of PICC via upper limb and lower limb venipuncture. Two reviewers independently evaluated and cross‐checked the quality of the included studies in accordance with the quality standards of the Cochrane Manual. We used RevMan 5.3 software for statistical processing.ResultsA total of 12 RCTs were included in this meta‐analysis. Meta‐analysis indicated that compared with upper limb veins, PICC insertion through lower limb veins is beneficial to increase the one‐time puncture success rate (relative risk [RR] = 0.73, 95% confidence interval [CI]: 0.68–0.79) and the indwelling time (mean difference [MD] = −3.60, 95% CI: −5.35 to −1.86), reduce the operation time (MD = 10.37, 95% CI: 7.48–13.26), estimated bleeding volume (MD = 0.55, 95% CI: 0.34–0.75), incidence of catheter ectopia (RR = 2.46, 95% CI: 1.81–3.35), PICC‐associated infection (RR = 2.82, 95% CI: 1.65–4.83), exosmosis (RR = 2.45, 95% CI: 1.49–4.04, p < .001) and phlebitis (RR = 1.40, 95% CI: 1.03–1.90). No significant difference in the Incidence of catheter obstruction between the upper and lower limb veins (RR = 1.20, 95% CI: 0.73–1.97, p = .48) was found.Public ContributionThere are certain advantages in neonatal PICC puncture through the lower limb vein. The lower limb vein may be the preferred choice for neonatal PICC puncture.

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Extravascular collection of fluid around the vertebra resulting from malpositioning of a peripherally inserted central venous catheter in extremely low birth weight infants

Cited by 14 publications

References 3 publications

The mysterious pleural effusion

The mysterious pleural effusion

Repositioning techniques of malpositioned peripherally inserted central catheters

Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta‐analysis of randomized controlled trials

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