Tamponade and massive pleural effusions secondary to peripherally inserted central catheter in neonates–A complication to be aware of

Abstract

BackgroundPeripherally inserted central catheters (PICC) are frequently used in neonatal intensive care units (NICU) to assist premature and critically ill neonates. Massive pleural effusions, pericardial effusions, and cardiac tamponade secondary to PICC are extremely uncommon but have potentially fatal consequences.ObjectiveThis study investigates the incidence of tamponade, large pleural, and pericardial effusions secondary to peripherally inserted central catheters in a neonatal intensive care unit at a tertiary care center over a 10-year period. It explores possible etiologies behind such complications and suggests preventative measures.Study designRetrospective analysis of neonates who were admitted to the NICU at the AUBMC between January 2010 and January 2020, and who required insertion of PICC. Neonates who developed tamponade, large pleural, or pericardial effusions secondary to PICC insertion were investigated.ResultsFour neonates developed significant life-threatening effusions. Urgent pericardiocentesis and chest tube placement were required in two and one patients, respectively. No fatalities were encountered.ConclusionThe abrupt onset of hemodynamic instability without an obvious cause in any neonate with PICC in situ should raise suspicion of pleural or pericardial effusions. Timely diagnosis through bedside ultrasound, and prompt aggressive intervention are critical.

Cardiac Tamponade Due to Pericardial Effusion Following Peripherally Inserted Central Catheter: A Single-Institution Case Series

“…This phenomenon is also described in the literature, the clinical presentation and the patient's hemodynamics substantially hang on the velocity of fluid accumulation and influence the decision to intervene. When the PCE accumulates rapidly or presents as tamponade, pending tamponade, or is causing significant respiratory or hemodynamic instability, pericardiocentesis is usually performed [ 13 ]. In the last two years, we have implemented POCUS.…”

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

“…Therefore, radiography is inaccurate and time-consuming, which limits the identification and diagnosis of PCE (19). Conventional radiology cannot be considered the "gold standard" for ECC tip location (20). In contrast, bedside echocardiography can help visualize the catheter position in relation to the heart, allow real-time localization of the catheter tip, identify and evaluate the degree of PCE to confirm the diagnosis, and identify the presence of cardiac compression with pericardial tamponade (21).…”

“…Therefore, pericardial effusion can be asymptomatic or a life-threatening event. The abrupt onset of hemodynamic instability without an obvious cause with a CVC in situ should raise suspicion of pericardial effusions (20,25). POCUS can also be used as a localization tool to assist in pericardiocentesis and reduce the exposure of infants to radiation (26).…”

A Comparison of In Vitro Measurement and Ultrasound for Peripherally Inserted Central Catheter Placement in Premature Infants: A Before-and-After Self-Controlled Prospective Study

“…Notably, PICC is recognized for its safety, durability, and low infection rates as a venous access method, positioning it as a particularly suitable option for newborns, especially premature infants grappling with significant nutritional deficiencies [ 2 ]. Given their developmental immaturity, premature infants often require sustained parenteral nutrition, a need effectively met by the PICC technique [ 3 ].…”