Iatrogenic Chylothorax Due to Pleural Cavity Extravasation of Total Parenteral Nutrition in Two Adults Receiving Nutrition through a Peripherally Inserted Central Catheter

Abstract

Extravasation of total parenteral nutrition (TPN) delivered via central lines is a known potential complication, but significant extravasations of infusate into the pleural space when using peripherally inserted central catheters (PICCs) have not been reported in adults. We report 2 cases ofpleural cavity extravasation ofTPN delivered via a PICC. Measurement of the glucose level of the effusate is a quick way to determine the presence of TPN and should be considered in any patient receiving TPN via any type of central line with a rapidly developing effusion.

Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study

“…The pleura is one of the most common sites of PN extravasation ( 1 ). The presence of high levels of glucose and low cell counts in the drained fluid suggests ECC-related PE ( 11 , 12 ). An accurate diagnosis is the cornerstone of effective treatment planning and therapy.…”

“…The pleura is one of the most common sites of PN extravasation (1). The presence of high levels of glucose and low cell counts in the drained fluid suggests ECC-related PE (11,12).…”

Chylothorax as a complication of extensive spontaneous left arm DVT

“…Our patient had no such intervention making it a unique case 9–12. Diagnosis of chylothorax is suspected on encountering milky looking pleural effusion, but it is important to realise that the differential diagnosis can also include empyema, cholesterol effusion, inadvertent infusion of propofol into the pleural cavity or inadvertent infusion of total parentral nutrition (TPN) into the pleural cavity 14–16. The diagnosis is made with fluid analysis, a TG level with a threshold of >110 mg/dL is commonly used to define chylothorax 17.…”

Differential diagnosis of chylothorax in therapeutic practice

“…При катетеризации подключичной вены могут произойти повреждение грудного лимфатического протока или обширный венозный тромбоз, которые способны привести к двустороннему хилотораксу и хилоперикарду [35]. Сообщается о случаях ятрогенного хилоторакса при парентеральном питании смесями, содержащими высокую концентрацию триглицеридов, которые попадают из центральной вены в плевральное пространство [36,37]. Хилезный выпот может возникнуть, когда назогастральная энтеральная трубка входит в плевральное пространство, либо в результате перфорации пищевода, либо при смещении в трахею с перфорацией париетальной плевры с вливанием липидов, содержащихся в препаратах энтерального питания [38].…”