Abstract:Tamponamento cardíaco em dois recém-nascidos causado por cateter umbilical
Cardiac tamponade caused by central venous catheter in two newborns
AbstractCardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical veno… Show more
“…However, the cannulation for a central venous catheter (CVC) can place patients at risk, with fatal complications such as arrhythmia [3], pneumothorax [4], inadvertent arterial puncture [5], hemothorax [6] or cardiac tamponade [7,8]. …”
BackgroundUnlike its use during stable conditions, central venous pressure (CVP) monitoring from a peripherally inserted central venous catheter (PICC) has not often been used in surgeries with significant hemodynamic alterations. The aim of this study was to evaluate the feasibility of measuring PICC pressure (PICCP) as an alternative to measuring centrally inserted central catheter pressure (CICCP) in adult liver transplantation (LT) patients.MethodsWe measured PICCP and CICCP simultaneously during each main surgical period in adult LT. Statistical analysis was performed using simple linear regression analysis to observe whether changes in PICCP paralleled by simultaneous changes in CICCP. Correlation analysis and Bland-Altman analysis were used to determine the degree of agreement between the two devices. Differences were considered statistically significant when P values were less than 0.05.ResultsA total of 1342 data pairs were collected from 35 patients. The PICCPs and CICCPs were highly correlated overall (r = 0.970, P < 0.001) as well as at each period measured. The differences among each period were not clinically significant (0.33 mmHg for pre-anhepatic, 0.32 mmHg for anhepatic, -0.15 mmHg for reperfusion, and -0.10 mmHg for neohepatic periods). The overall mean difference was 0.14 mmHg (95% confidence interval: 0.09-0.19) and PICCP tended to give a higher reading by between 0.09 and 0.19 mmHg overall. The limit of agreement was -1.74 to 2.02 overall.ConclusionsThese findings suggest that PICCP can be a reasonable alternative to CICCP in situations of dynamic systemic compliance and preload, as well as under stable hemodynamic conditions.
“…However, the cannulation for a central venous catheter (CVC) can place patients at risk, with fatal complications such as arrhythmia [3], pneumothorax [4], inadvertent arterial puncture [5], hemothorax [6] or cardiac tamponade [7,8]. …”
BackgroundUnlike its use during stable conditions, central venous pressure (CVP) monitoring from a peripherally inserted central venous catheter (PICC) has not often been used in surgeries with significant hemodynamic alterations. The aim of this study was to evaluate the feasibility of measuring PICC pressure (PICCP) as an alternative to measuring centrally inserted central catheter pressure (CICCP) in adult liver transplantation (LT) patients.MethodsWe measured PICCP and CICCP simultaneously during each main surgical period in adult LT. Statistical analysis was performed using simple linear regression analysis to observe whether changes in PICCP paralleled by simultaneous changes in CICCP. Correlation analysis and Bland-Altman analysis were used to determine the degree of agreement between the two devices. Differences were considered statistically significant when P values were less than 0.05.ResultsA total of 1342 data pairs were collected from 35 patients. The PICCPs and CICCPs were highly correlated overall (r = 0.970, P < 0.001) as well as at each period measured. The differences among each period were not clinically significant (0.33 mmHg for pre-anhepatic, 0.32 mmHg for anhepatic, -0.15 mmHg for reperfusion, and -0.10 mmHg for neohepatic periods). The overall mean difference was 0.14 mmHg (95% confidence interval: 0.09-0.19) and PICCP tended to give a higher reading by between 0.09 and 0.19 mmHg overall. The limit of agreement was -1.74 to 2.02 overall.ConclusionsThese findings suggest that PICCP can be a reasonable alternative to CICCP in situations of dynamic systemic compliance and preload, as well as under stable hemodynamic conditions.
“…However, some studies have used ultrasound examination to demonstrate the incorrect positioning of catheters that the radiological examination showed to be ideally located [10][11][12] .…”
Section: Discussionmentioning
confidence: 99%
“…Some studies have shown that there is no difference in the risk of death from cardiac tamponade related to PICC for factors such as gestational age and weight 16,17 . Regarding general mortality among newborns with this condition, Nowlen et al 16 12,20,21 , reviews or meta-analyzes [15][16][17] . In the last 13 years, there have been original studies evaluating the complications related to the use of PICC 7,8,19,22 .…”
Section: Discussionmentioning
confidence: 99%
“…In the last 13 years, there have been original studies evaluating the complications related to the use of PICC 7,8,19,22 . However, there are few Brazilian studies on the subject that are not case reports 12,20 . Our work involves four cases, three of which proven to be related to PICC insertion and without mortality,…”
the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.
“…This complication occurs in up to 3% of the newborn cases with central venous access. [ 1 ] We report a case of cardiac tamponade following central venous cannulation that was diagnosed using a transthoracic echocardiography, managed by urgent surgical pericardial drainage. Complications with central line insertion in neonates occur most likely with guide wire aided insertion, with blind needling of a chest vein and with dilators.…”
Cardiac tamponade following central line in a neonate is rare and an uncommon situation; however, it is potentially reversible when it is diagnosed in time. We report a case of cardiac tamponade following central line insertion. A 10-day-old 2.2 kg girl operated for obstructed total anomalous pulmonary venous connections had neckline slipped out during extubation. Attempted cannulations of right femoral vein were unsuccessful. At the end of the left internal jugular vein cannulaton, there was a sudden cardiorespiratory arrest. Immediate transthoracic echocardiogram showed left pleural and pericardial collection. Chest was opened and the catheter tip was seen in the thoracic cavity after puncturing the innominate vein. The catheter was removed and the vent was repaired.
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