Journal of Neonatology & Clinical Pediatrics Category: Clinical Type: Case Report
Pleural Effusion as a Complication of Umbilical Venous Catheter
- Sara Machado Rocha1*, Catarina M Lacerda2, Margarida Rosal3, Carla David3, Teresa Tomé3
- 1 Department Of Pediatrics, Hospital De Santarém, Santarém, Portugal
- 2 Department Of Pediatrics, Centro Hospitalar Barreiro-Montijo, Santarém, Portugal
- 3 Department Of Pediatrics, Centro Hospitalar De Lisboa Central, Santarém, Portugal
*Corresponding Author:Sara Machado Rocha
Department Of Pediatrics, Hospital De Santarém, Santarém, Portugal
Received Date: Nov 15, 2018 Accepted Date: Dec 06, 2018 Published Date: Dec 20, 2018
CLINICAL CASE REPORT
The chest radiograph showed recurrence of the right pneumothorax, due to chest tube malposition (Figure 1). The chest tube was replaced, with an initial drainage of air and serohematic fluid that turned into milky/yellowish (Figure 2), in a total of 164 ml. Cytochemical examination of pleural fluid revealed a predominance of polymorphonuclear cells and a high glucose concentration (1173 mg/dL) that is compatible with parenteral nutrition solution. Peripherally inserted central catheter was placed and UVC removed. After catheter removal, mean arterial pressure, urine output and blood glucose normalized and there was no recurrence of pleural effusion. Chest tube was removed on the fourth day and post-procedure chest radiograph showed clear parenchymal lung fields. Blood culture was sterile, therefore antibiotics were stopped at day 5. The infant remained intubated for 40 days and received parenteral nutrition for 42 days. He was discharged without oxygen at 77th day of life. Brain ultrasound at discharge was normal.
Correct positioning of the UVC is critical in order to prevent life-threatening complications . The optimal position of the UVC tip is considered to be just above the diaphragm in the thoracic inferior vena cava or at the cavoatrial junction. The current standard technique used worldwide to localize the catheter tip is Anteroposterior (AP) chest radiography, since it was introduced by Peck and Lowman in 1967 . However, cases have been reported suggesting that complications could occur even when AP chest radiographs revealed a proper position of catheter’s tip [7,8]. Lateral views increase the accuracy of chest radiograph in predicting the location of UVC tip, but it results on greater exposure of neonate to radiation . Recently, studies have demonstrated that echocardiography is superior to AP chest radiographs for UVC tip localization [2,10].
We should not forget to check the catheter’s tip location after any repositioning, and re-evaluate it regularly is mandatory. When malpositioned or in doubtful position, catheters should be withdrawn as early as possible, ensuring an alternative access. If the clinical situation does not allow it, it is important to consider the osmolarity of the perfused solutions, due to the risk of endothelial damage.
CONFLICT OF INTEREST
CONTRIBUTOR’S STATEMENT PAGE
Catarina M Lacerda: Reviewed and revised the manuscript.
Margarida Rosal, Carla David and Teresa Tomé: Served as scientific advisors and critically reviewed the manuscript.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Citation:Rocha SM, Lacerda CM, Rosal M, David C, Tomé T (2018) Pleural Effusion as a Complication of Umbilical Venous Catheter. J Neonatol Clin Pediatr 5: 026.
Copyright: © 2018 Sara Machado Rocha, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.