Severe Hyponatremia Secondary to Peripherally Inserted Central Catheter in a Neonate

Tseng, Min‐Jen; Lin, Shih‐Hua; Chung, Hung-Tao; Hsu, Teng-Chin; Lien, Reyin; Huang, Jing‐Long; Chiang, Ming-Chou

doi:10.1016/j.pedneo.2015.08.010

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…In this study, echocardiography indicated that the CVC tip was too deep in 18 (18/25, 72%) infants when PCE occurred. CVCassociated PCE can be caused by atrial wall perforation resulting from mechanical injury caused by the CVC tip, but it is most commonly caused by erosion of the right atrial wall (13)(14)(15). In this study, the CVC tips were correctly positioned in 5 (5/25, 20%) infants when PCE occurred, with persistent infusion of partial parenteral nutrition, suggesting that persistent infusion of high permeability liquid can damage the endothelial cells and endocardium.…”

Section: Discussionmentioning

confidence: 59%

“…The increase in the pericardial cavity pressure resulted in a limitation in the cardiac diastolic function, a decrease in cardiac output, and an accumulation of a large fluid volume in the pericardial cavity within a short period, leading to rapid symptom onset. In this study, infants mainly manifested respiratory and circulatory symptoms, rapid progression to multiorgan and multi-system involvement, and internal environmental disturbances (14). Both infants who eventually died had convulsions, which were considered to be related to the development of severe hypoxia, irreversible metabolic acidosis, and internal environmental disturbances.…”

Section: Discussionmentioning

confidence: 91%

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The advantage of point-of-care ultrasound in central venous catheterization and related pericardial effusion in infants in the NICU

Zhang,

Yan,

Liu

2023

Front. Pediatr.

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BackgroundCentral venous catheterization (CVC) is broadly used in neonatal intensive care units (NICUs) for efficient vascular access; however, its establishment and maintenance are associated with numerous risks and complications. Here, we focus on investigating the value of point-of-care ultrasound (POCUS) in the early diagnosis and treatment of pericardial effusion associated with CVC and compare the differences in ultrasound and radiography in CVC localization and monitoring in the NICU.MethodsTwenty-five infants with CVC-associated pericardial effusion (PCE) who were hospitalized in the NICU of Peking University Third Hospital between January 2013 and March 2023 were retrospectively selected for the study. Data concerning their catheterization characteristics, CVC tip position, clinical and imaging manifestations of PCE, treatments, and prognoses were analyzed.ResultsThe mean gestational age of our cohort was 29.3 ± 3.1 weeks, and the mean birth weight was 1,211 ± 237 g. The incidence of CVC-associated PCE was 0.65%, and 80% of PCE cases occurred within 4 days of CVC. After PCE, the most common symptoms were tachypnea (44%) and tachycardia (64%). Chest radiographs revealed cardiothoracic enlargement, and only 2 cases (9.10%) showed a “flask heart”. Cardiac ultrasound showed that the catheter tip extended deep into the heart in 72% of infants with PCE. Cardiac insufficiency was observed in 12 cases (48%). Overall, 8 infants (32%) had pericardial tamponade, 7 (87.5%) of whom underwent pericardiocentesis. Overall, 2 (8%) infants died, and the remaining 23 (92%) were cured.ConclusionCVC-associated PCE mostly occurs in the early post-catheterization stages (within 4 days) in infants. Some cases may have critical clinical manifestations and progress rapidly, with some even developing pericardial tamponade. A CVC tip being deep into the heart cavity is an important cause of PCE. Compared with chest radiography, point-of-care ultrasound is more accurate for CVC tip positioning and can detect PCE more quickly. Furthermore, it is more advantageous for locating and monitoring CVC-associated PCE. Early identification and diagnosis can effectively reduce fatality rates and improve the prognosis of infants with CVC-associated PCE.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 91%

The advantage of point-of-care ultrasound in central venous catheterization and related pericardial effusion in infants in the NICU

Zhang,

Yan,

Liu

2023

Front. Pediatr.

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“…The incomplete filling of the atria and ventricles leads to a reduction in cardiac output, resulting in severe hemodynamic disturbances, circulatory failure, and organ dysfunction. [ 4 , 7 , 8 ] Therefore, vigilance is imperative in detecting the possibility of pericardial effusion when a neonate presents with poor responsiveness, pallor and/or cyanosis, altered respiratory rate, diminished heart sounds, tachycardia/bradycardia, weak peripheral pulses or prolonged capillary refill time, [ 19 , 20 ] and early recognition and prompt management are paramount.…”

Section: Discussionmentioning

confidence: 99%

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

Liu,

Li,

Shi

et al. 2023

Medicine

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Rationale: Peripherally inserted central catheter (PICC)-related pericardial effusion/cardiac tamponade is a rare but fatal complication which cause a high mortality if not timely diagnosed and treated. However, the atypical manifestations and the rapid deterioration present challenges for neonatologists, and there has been limited investigation reported globally to date. Furthermore, a systematic review and comprehensive summary of clinical management are lacking. The significance of this article lies in emphasizing the importance of maintaining vigilance in high-risk neonates and implementing effective management strategies for PICC-related pericardial effusion/cardiac tamponade, thereby contributing to saving more lives. Patient concerns: In the current report, we discuss 2 cases of neonatal pericardial effusion/cardiac tamponade following PICC catheterization. Diagnosis: The first case was diagnosed based on forensic autopsy and the second case was diagnosed by bedside echocardiography. Interventions and outcomes: The first case was treated conservatively and the second case underwent pericardiocentesis, unfortunately both were died. Lessons: Once sudden hemodynamic or respiratory abnormalities are detected in neonates with PICC placement, particularly in the preterm infants, prompt diagnosis by cardiac ultrasound is required to verify pericardial effusion/cardiac tamponade and immediate pericardiocentesis or pericardiotomy is necessary to improve survival.

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“…There are an increasing number of reports of the rising prevalence of hyponatremia, e.g., Nair et al ( 9 ), Lobo-Rodríguez et al ( 10 ), and Gandhi et al ( 11 ) even in children (who surely should not be given a low salt diet) ( 12 ), including neonates ( 13 ) and athletes who drink too much water when losing salt through sweating ( 14 , 15 ). Pituitary deficiency of ACTH ( 16 ), subarachnoid hemorrhage ( 17 ), osteoporosis, failure of salt supplementation with medical treatments ( 18 ), thiazide treatment in the elderly ( 19 ), and thiazide and psychotropic drugs combined ( 20 ) have all been associated with severe hyponatremia.…”

Section: The Increasing Prevalencementioning

confidence: 99%

The Hyponatremia Epidemic: A Frontier Too Far?

Drake-Holland

Noble

2016

Front. Cardiovasc. Med.

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Hyponatremia is the most common electrolyte abnormality and is often neglected, especially in elderly and seemingly terminal patients. Hyponatremia can be asymptomatic or can cause symptoms ranging from nausea and lethargy to convulsions and coma. This condition has become increasingly common over time with a similar time course to the increase in adoption of low salt diets. The popularization of low salt may not be justified in people with normal kidney function in whom the compatible statistically based evidence that salt causes hypertension has been challenged by experimental evidence to the contrary.

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Severe Hyponatremia Secondary to Peripherally Inserted Central Catheter in a Neonate

Cited by 4 publications

References 9 publications

The advantage of point-of-care ultrasound in central venous catheterization and related pericardial effusion in infants in the NICU

The advantage of point-of-care ultrasound in central venous catheterization and related pericardial effusion in infants in the NICU

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

The Hyponatremia Epidemic: A Frontier Too Far?

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