Unilateral pleural effusion complicating central venous catheterisation

Abstract

Acute respiratory distress developed in two preterm babies because of unilateral hydrothorax secondary to the migration of a central venous catheter into the pulmonary vasculature. Prompt recognition of the problem and rapid treatment are essential and life saving. This complication of intravenous alimentation catheters has not been previously reported in the neonatal age group. (Arch Dis Child Fetal Neonatal Ed 2000;82:F248-F249)

Variation in identifying neonatal percutaneous central venous line position

“…Although there are recommendations to avoid the right atrium entirely when positioning long line tips 7,8 other practitioners report this as a safe position 15 . Complicating localization of long lines even further, movement and migration of the line tips has been reported 10,11 and position of the infant may affect the line position on an hour to hour basis.…”

“…Pericardial effusion particularly may be associated with tamponade and infant death 6,7 . The UK Department of Health (DOH) guidelines recommend that the tip of the central line be positioned outside the chambers of the heart 8 although positioning the line tip outside the heart is still associated with complications 9 and migration is a recognized occurrence 10,11 .…”

Efficacy of ultrasound-guided thoracentesis catheter drainage for pleural effusion

“…In particular, the application of central venous catheters in pleural effusion has proven to be an effective, safe and economical method (24,25). The first and crucial step of thoracentesis is choosing a puncture point.…”

“…Currently, thoracentesis catheter drainage is mainly via central venous catheter (24,25). It has the traits of flexibility and good tissue compatibility but is easily blocked.…”

Neonatal long lines

“…Hypoglycaemia caused by interruption of the intravenous infusion may provide a clue to the problem. Accumulation of infusate has been described in the subarachnoid space (line tip in the lumbar plexus 15 ), renal pelvis (renal veins 16 ), peritoneal cavity, retroperitoneal space or externally from the abdominal wall (epigastric vein 17 ) with lower limb lines, and in the pleural space (pulmonary veins 18 ) with upper limb lines. Obtaining x ray pictures in more than one plane may be useful for positioning lower limb peripherally inserted central lines, although only repeated imaging will pick up catheter migration after insertion.…”