Right-Sided Hydrothorax and Central Venous Catheters in Extremely Low Birthweight Infants

Abstract

Central venous catheters (CVCs) have become more common in the care of very low birthweight newborns. Nutrition is enhanced, fluid delivery is more secure, and stress from the intervention of starting new IVs is reduced. Complications of these devices include infection, thrombus or embolus, damage to vessels and organs, and extravascular collections of fluid. Pleural fluid collections can occur due to superior vena caval obstruction with obstruction of lymphatic drainage, and erosion or perforation of the catheter through the vein into the pleural space. Three infants weighing less than 1000 gm had CVCs placed in an antecubital vein. Severe respiratory compromise developed in 1 at 5, 1 at 6, and 1 at 40 hours after line placement, and chest radiograph suggested fluid in the right pleural space. Milky fluid was found in two cases in which the infants received lipid emulsion and parenteral nutrition fluid (PNF). Bright yellow fluid, resembling PNF, was found in the third, not receiving lipids. None of the patients was enterally fed. The tips of the CVCs were adjusted to a more peripheral location and there was no recurrence of pleural fluid, nor were signs of superior vena cava syndrome seen. Etiologies for the unilateral hydrothorax include vein perforation and erosion, but another cause is discussed. A right pleural fluid collection in a patient with a CVC tip in the right subclavian vein is a serious problem, which may be solved with repositioning of the CVC instead of removal.

Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study

“…Misplacement of a PICC can lead to the development of pleural effusion, perforation of the vessel, etc. [36,37,38]. On the other hand, misplacement of a UVC out of the inferior vena cava may cause liver injury (which often leads to elevated liver enzymes), portal hypertension, hepatic necrosis, and/or effusions [39,40,41].…”

Percutaneously Inserted Central Catheter–Related Pleural Effusion in a Level III Neonatal Intensive Care Unit: A 5‐Year Review (2008–2012)

“…Infiltration is more common if the catheter tip is noncentrally located, especially if it is located in the midclavicular area for upper limb PICC 4 . The reported mechanisms of PICC‐related PLE include (a) vessel perforation during catheterization, (b) retrograde passage of a central venous catheter into the lymphatic duct, (c) erosion of the vein, and (d) hyperosmotic endothelial damage, leading to increased vascular permeability and thrombosis 5 – 7 . In this study, we focused on PICC‐related PLE, as the pleura is of one the most common sites of extravasation of PN.…”

“…We also performed a comprehensive literature review of published PICC‐related PLE reports, summarized in Table 2 2 , 5 , 7 , 9 – 20 . We reanalyzed these reports using our definition of central catheter tip position and found that 9 tips were in a central position, 6 were in a noncentral position, and 6 were positioned too deeply into the right atrium.…”

The Cobweb Sign: Percutaneous Silastic Long Line Tip Placement in Tributaries of Superficial Veins

“…Other major complications include perforation of the vein or heart resulting in extravasation leading to hydrothorax, ascites, pericardial and pleural effusions. [2][3][4][5] In each of our reported cases the percutaneous catheter tip was in a tributary of the superficial veins. In two cases, there was extravasation within 38 to 72 hours of use while in the third this Contrast X-ray of long line; the tip of the long line is in a vein at the hip joint (large arrow) and from the tip, thin rays of contrast could be traced in both lateral and medial directions which is ending in two areas of accumulation of contrast (medium and small arrows).…”

“…While these lines have helped in saving lives, a range of hazards including septicaemia, venous thrombosis, extravasation, cardiac tamponade, chemical pneumonitis, hydrothorax and retroperitoneal extravasation of central lines have been reported. [2][3][4][5] The correct positioning of the tip of the long line is considered important to minimise these complications. The exact site of the line tip can be confirmed by contrast X-ray.…”