Pneumothorax as a rare complication of peripherally inserted central catheter (PICC) in neonates: A case report study

Abstract

Introduction and importance The Peripherally Inserted Central Catheter (PICC) placement is associated with complications such as deep vein thrombosis, phlebitis, air embolism, infection, and superior vena cava syndrome. The aim of this study is to report pneumothorax as a rare complication of PICC insertion in a newborn. Case presentation The present case report is of a 32-week- and 4-day-old female fetus who was born at Mahzad Obstetrics and Gynecology Hospital, Urmia, Iran. A PICC was placed for the infant. The infant underwent an antero–posterior chest X-ray, in which the presence of a complete white-out of the right hemithorax indicated pneumothorax and right lung collapse. The review of literature in this field showed that there were no reports of pneumothorax as a complication of PICC insertion in neonates. Clinical discussion Despite that the PICC placement seems to have many medical advantages in infants, it may cause life-threatening complications such as pneumothorax. In this newborn, the PICC placement was the main cause of pneumothorax and it can be stated that the catheter tip might cause trauma to the chest wall during the placement procedure which resulted in an air trap in the pleural cavity and eventually right lung collapse. Conclusion There are a couple of rare cases being reported to have complications of PICC placement in neonates, but none had associated pneumothorax and PICC placement in neonates. Therefore, innovative methods require to be used for meeting the nutrition and fluid requirements of the infants for a long time.

Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax

“…Punctures that include upper extremity block, subclavian or intrajugular venous puncture catheterization, are less successful and have complications[ 24 ]. Goli et al [ 25 ] reported a 32-wk premature infant who underwent peripherally inserted central catheter (PICC) catheterization at 4 d of birth. After the PICC was placed for 2 h, the baby’s oxygen saturation decreased to 45%, and the baby developed tachycardia and shortness of breath.…”

Treatment of severe extravasation injury in a newborn by using tilapia fish skin: A case report

“…Infants, especially premature newborns, need an environment that is equipped with advanced medical technology and specialized nursing care in order to survive, but unfortunately, this environment inadvertently endangers the baby's organs [3] . In the NICU, the insertion of an intravenous catheter is a common procedure for venipuncture, blood pressure measurement, and administering intravenous fluids, or intravenous nutrition and medication [4] . Approximately 95% of peripheral venous catheters are removed due to complications such as infections, phlebitis, vessel rupture and drug leaks or serum.…”

Saving the right arm to place the peripherally inserted central catheter (PICC) in premature infants

“…PICCs are usually inserted into large peripheral veins (to deliver drugs and nutrients over a long period of time, because a large vein can tolerate a IV catheter longer than a small vein) of the arm, such as the cephalic vein or the basilic vein near the elbow, and guided toward the superior vena cava ( Fig. 1 ) 5 . Since the most appropriate and convenient place for vascular access to insert the PICC is the basal and cephalic veins in the right arm of the infant, so it is recommended that infants who are preterm and may be hospitalized for a long time save the right arm.…”

“…Considering the long length of stay of preterm infants in the neonatal intensive care unit and the poor stability of peripheral venous access, another means of venous access is needed [4] . Indeed, venous access is an important dimension of treatment in neonates [5] . The peripheral central catheter (PICC) is a long, thin catheter made of soft, flexible silicone or polyurethane [6] .…”