Neonatal cardiac tamponade, a life-threatening complication secondary to peripherally inserted central catheter: a case report

Abstract

Background Although the use of a peripherally inserted central catheter (PICC) has many advantages for the treatment of neonates, catheter malposition may result in serious complications that could be life-threatening. We report the case of a 10-day-old neonate with cardiac tamponade secondary to a PICC line who was successfully treated by pericardiocentesis. Case presentation An Iranian (Asian) preterm male neonate was born by Cesarean section with a birth weight of 1190 g and a first-minute Apgar score of 7. Based on an increased respiratory distress syndrome (RDS) score from 4 to 7, resuscitation measures and intubation were performed at the neonatal intensive care unit (NICU). On day 3 after birth, a PICC line was inserted for parenteral therapy. A chest X-ray confirmed that the tip of the PICC line was in the appropriate position. Mechanical ventilation was discontinued 72 h post-NICU admission because of the improved respiratory condition. On the day 10 post-NICU admission, he suddenly developed hypotonia, apnea, hypoxia, hypotension, and bradycardia. Resuscitation and ventilation support were immediately started, and inotropic drugs were also given. Emergency echocardiography showed a severe pericardial effusion with tamponade. The PICC line was removed, and urgent pericardiocentesis was carried out. The respiratory situation gradually improved, the O2 saturation increased to 95%, and vital signs remained stable. Conclusions Dramatic improvement of the neonate's clinical responses after pericardial drainage and PICC removal were suggestive of PICC displacement, pericardial perforation, and cardiac tamponade.

Peripherally inserted central catheter related pericardial effusion/cardiac tamponade in neonates: Analysis of two cases and literature review

“…As shown in Table 1, from the beginning of the 21 st century, including our 2 cases reported herein, a total of 35 cases of PICC-related neonatal pericardial effusion/cardiac tamponade have been reported in China and abroad, [3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18] with an average GA of (29.7 ± 3.7) weeks and an average BW of (1243.3 ± 517.3) g. Normally, there are about 5 ml of pericardial fluid in the pericardial cavity of newborns, and a small amount of fluid serves as lubrication to reduce friction during cardiac contraction. [8] However, when a significant accumulation of fluid occurs within the pericardium, the pressure within the pericardial cavity increases, thereby limiting cardiac diastolic function correspondingly.…”

“…Right pulmonary artery Pericardiotomy Cured Zarkesh et al [17] 1 30 wk 1190 g Right upper limb (detailed location not specified) Not specified Pericardiocentesis Cured Cui et al [18] 1 32 wk 1570 g…”