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

Abstract

Background: Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position. Objective: To investigate the causes and preventive measures of ECC-related PE in neonates. Methods: This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated. Results: ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero ( P < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site ( P < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without ( P < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively. Conclusion: ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.

The positioning of the catheter tip with an intracavitary electrocardiogram in epicutaneo–caval catheter placement via lower limbs in newborns: A retrospective study

“…Few studies have investigated whether catheterisation through the lower limb pathway is suitable for intracavitary ECG technology, though some researchers indicated that catheterisation via this route has good safety and reliability. 5 To further explore the effectiveness and sensitivity of intracavitary ECG technology in the positioning of lower limb ECC tips in neonates, 28 cases of ECCs inserted via the lower limbs in the neonatal intensive care unit of our hospital were positioned by using an ECG lead. These cases were compared to a control group using chest and abdomen X-rays to determine the effect of intracavitary ECG technology in the neonatal lower limb ECC placement.…”

“…Few studies have investigated whether catheterisation through the lower limb pathway is suitable for intracavitary ECG technology, though some researchers indicated that catheterisation via this route has good safety and reliability. 5…”

Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study

“…No significant difference was noted between the two groups regarding the other catheter-related complications. No serious or long-term complications, for example, cardiac arrhythmia, accidental arterial puncture, cardiac tamponade, pericardial or pleural effusion,15 was noted in both groups across the 3 years.…”

Marcos anatômicos na radiografia para cateter central periférico em neonatos: revisão integrativa

“…(26) Em relação ao método, 12 eram estudos observacionais (um caso-controle, (22) dois transversais (19,21) e nove coortes. (14)(15)(16)18,20,(23)(24)(25)(26) Um ensaio clínico randomizado foi incluído. (17) Quanto ao país de origem, 12 eram internacionais: cinco foram realizados na China, (15,17,20,25,26) dois nos Estados Unidos da América (14,22) e um estudo na Itália, (16) Alemanha, (18) Canadá, (21) Irã (23) e Índia.…”

“…(14)(15)(16)18,20,(23)(24)(25)(26) Um ensaio clínico randomizado foi incluído. (17) Quanto ao país de origem, 12 eram internacionais: cinco foram realizados na China, (15,17,20,25,26) dois nos Estados Unidos da América (14,22) e um estudo na Itália, (16) Alemanha, (18) Canadá, (21) Irã (23) e Índia. (24) Apenas uma publicação brasileira foi elegida.…”