Faculty Collaboration Database

[Iatrogenic pleuropneumonia complicating central venous cannulation in a very low birth weight infant]. Anestezjol Intens Ter 2010;42(3):147-50

Date

03/19/2011

Pubmed ID

21413420

Scopus ID

2-s2.0-80052617024 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Central venous cannulation is necessary for long-term parenteral nutrition in premature infants. Peripherally inserted long catheters are commonly used in these patients but even this relatively simple technique can end in serious complications. We present a case in which perforation of the vena cava and migration of the catheter to the intrapleural space resulted in multiple organ failure and death.

CASE REPORT: A 700 g bw. infant, born at 28 weeks of gestation, was referred to our centre because of suspected bowel perforation. In the referring hospital, the infant had a central venous catheter inserted peripherally. The catheter migrated to the right intrapleural space, and parenteral formula was delivered over several hours to the right pleura, resulting in hydrothorax with serious compression of the lung and atelectasis. Emergency laparotomy did not reveal any pathology and a chest tube was inserted into the right pleura; the effusion fluid contained a large number fat particles. The child's condition worsened and he died 16 days after surgery because of multiple organ failure and sepsis.

CONCLUSION: Accidental migrations of central venous catheters to the pleural space have been described by many authors. It can result in severe pneumonia, cardiac tamponade or sepsis and is often fatal. We conclude that central venous catheters in premature infants should be inserted under ultrasonography or fluoroscopy. Catheters should never be forced along vessels; their size ought to be adjusted to age, and a free outflow of blood should be obtained before they are used.

Author List

Jakubczyk M, Chrzanowska M, Apanasiewicz M, Chrupek M, Kaźmirczuk R, Reszczyńska M, Prokurat AI, Szkulmowski Z, Kusza K

Author

Magdalena Chrzanowska PhD Associate Professor in the Pharmacology and Toxicology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Catheterization, Central Venous
Fatal Outcome
Foreign-Body Migration
Humans
Hydrothorax
Iatrogenic Disease
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Male
Multiple Organ Failure
Parenteral Nutrition
Pleura
Pleuropneumonia