Massive pleural effusion on the contralateral side of a venous peripherally inserted central catheter

Abstract

A preterm newborn infant, delivered at 30 weeks of gestation and 965 g birth weight, developed respiratory distress with resistant hypoxia after a central catheter line was inserted via the right venae brachialis on postnatal day 21. Left-sided massive pleural effusion, collapsed left lung with air bronchograms, and bidirectional shunting through reopened ductus arteriosus were detected by targeted neonatal echocardiography. Hydrothorax was drained under sonographic guidance, producing a milky-white fluid biochemically compatible with parenteral nutrition. We report this case of hydrothorax secondary to a misplaced central catheter on the contralateral side of its peripheral insertion. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:140-144, 2018.

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

“…In reports of ECC-related PE, most catheters were inserted from an upper extremity vein ( 1 – 4 , 6 , 13 , 15 ) but few were inserted from a lower extremity vein. Kua et al reported a case of ECC-related PE, in which the catheter was inserted from a lower extremity vein and located in the right iliac vein before migration to one of the tributaries of the azygous vein ( 12 ).…”

A misplaced peripherally inserted central catheter presenting as contralateral pleural effusion

“…During removal, we noted that the catheter’s length was the same as after insertion, suggesting that it had been misplaced at the time of insertion itself. A similar case of misplacement during insertion has been reported previously also 1. So, to avoid this complication, some authors suggest using real-time ultrasound-guided PICC line insertion by experienced neonatologists as it is shown to decrease the catheter insertion duration as well as fewer manipulations when compared with the conventional technique 5…”

“…It was reported that PICC line can cause perforation of vascular structures to reach cavities (pleural, peritoneal and pericardial ones), which happened in our case 1. Studies have shown that limb movement, neck position and forceful flushing while insertion may change the position of the tip of the PICC line 7.…”

“…Recently, Bashir et al reported an incidence of PICC-related pleural effusion as 0.4 per 1000 catheter days 4. Contralateral pleural effusions are reported but rarely compared with ipsilateral effusion 1. Pleural effusion in preterm neonates presents as tachypnoea, increased work of breathing, increased oxygen requirement, tachycardia which ultimately progress to hypoxia, recurrent apnoea and respiratory failure.…”

“…The procedure for PICC insertion is simpler and safe in experienced hands and has a lower complication rate than that of surgically placed central catheters leading to an increase in insertion rates of PICC lines in the last few years 1. However, PICC line use may be associated with a wide spectrum of complications (infiltration, occlusion, thrombosis, misplacement, migration, infection, breakage, superficial abdominal abscess) including rare but acute life-threatening events such as pericardial effusion, cardiac tamponade and massive pleural effusion 1–3.…”