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Table of Contents   
LETTER TO EDITOR  
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 108-109
Bilateral pleural effusion, cardiogenic shock, renal failure, and generalized anasarca: A dreaded iatrogenic complication of umbilical venous catheterization


1 Department of Pediatric Cardiology, Max Super Specialty Hospital, New Delhi, India
2 Department of Neonatology, Max Super Specialty Hospital, New Delhi, India

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Date of Web Publication19-Jan-2016
 

How to cite this article:
Garg G, Mandhan G, Sidana P. Bilateral pleural effusion, cardiogenic shock, renal failure, and generalized anasarca: A dreaded iatrogenic complication of umbilical venous catheterization. Ann Pediatr Card 2016;9:108-9

How to cite this URL:
Garg G, Mandhan G, Sidana P. Bilateral pleural effusion, cardiogenic shock, renal failure, and generalized anasarca: A dreaded iatrogenic complication of umbilical venous catheterization. Ann Pediatr Card [serial online] 2016 [cited 2019 Sep 19];9:108-9. Available from: http://www.annalspc.com/text.asp?2016/9/1/108/171409


Sir,

A 7-day-old preterm male baby (1.9 kg) was referred to us with cardiogenic shock and renal failure. After day 3 of life, the patient's condition gradually deteriorated and he started having tachypnea, tachycardia, and decreased urine output, and was referred to us on day 7. Umbilical venous catheter (UVC) was put on day 1 of life.

After admission, he required high-frequency ventilation because of massive pericardial and bilateral pleural effusion. Heart was structurally normal. Chest x-ray showed white out of both lung fields with UVC tip at the right place [Figure 1]. Echocardiography guided pericardial tapping was done immediately. By next morning, urine output improved, left lung became clear but right sided effusion was still there [Figure 2]. Mild pericardial fluid was collected again. Still being unclear about the cause, intercostal drain was put on the right side that was continuously draining clear fluid. To our surprise, pleural and pericardial fluid showed sugar level of 1,300 mg/dL. Blood sugar was in normal range. Now, it was clear from high sugar level in pleural and pericardial fluid that it was due to umbilical venous catheter. Hence, the UVC line was removed. Chest x-ray taken next day showed bilateral clear lung fields and disappearance of cardiomegaly [Figure 3]. The baby recovered well and got discharged after 3 days. He did well on a follow-up period of 2 months.
Figure 1: Chest x-ray shows white out of both lung fields. Umbilical venous catheter tip (black arrow) can be seen at the level of diaphragm

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Figure 2: Chest x-ray shows right-sided pleural effusion and cardiomegaly. Left-sided effusion has cleared. Umbilical venous catheter tip (black arrow) can be seen at the level of diaphragm

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Figure 3: Chest x-ray after removal of umbilical venous catheter shows bilateral clear lung fields. Heart size has also become normal

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UVCs are relatively easy to insert and have been widely used in sick newborns. However, they have been implicated in the causation of many problems, including arrhythmias, systemic and pulmonary embolization, myocardial perforation, pericardial effusion, pleural effusion, pulmonary infarction, hemorrhage, and catheter-related infections. [1],[2] Most complications are related to incorrect position of the catheter. The ideal position is suggested to be at the right atrial/inferior vena cava junction or in the thoracic inferior vena cava to minimize complications. [3],[4] Leakage of infusion fluid into the pericardial space can be caused by direct perforation of the myocardium during the insertion of the catheter. More often, however, it occurs several days later due to endothelial damage, caused by repetitive hitting of the myocardial wall by the catheter. [5]

Pleural and pericardial effusion caused by UVC is a well-known fact but the reason behind writing this letter is the different presentation in our case. Because there were bilateral pleural effusion, pericardial effusion, and generalized anasarca (instead of right pleural or pericardial effusion caused by UVC) on admission, we could not think about this cause. The condition in which we received the baby was a late manifestation of this complication that can be attributed to low cardiac output due to pericardial effusion. Ultimately, it was the high glucose levels in pleural and pericardial fluid that guided us in saving the life of the baby.

So, we conclude that bilateral pleural effusion and generalized anasarca can be a late and dreaded complication of umbilical venous catheterization. Timely intervention and presence of mind can save lives of such babies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Egan EA 2 nd , Eitzman DV. Umbilical vessel catheterization. Am J Dis Child 1971;121:213-8.  Back to cited text no. 1
    
2.
Mehta S, Connors AF Jr, Danish EH, Grisoni E. Incidence of thrombosis during central venous catheterization of newborns: A prospective study. J Pediatr Surg 1992;27: 18-22.  Back to cited text no. 2
    
3.
Paster S, Middleton P. Roentgenographic evaluation of umbilical artery and vein catheters. JAMA 1975;231:742-6.  Back to cited text no. 3
    
4.
Nadroo AM, Lin J, Green RS, Magid MS, Holzman IR. Death as a complication of peripherally inserted central catheters in neonates. J Pediatr 2001;138:599-601.  Back to cited text no. 4
    
5.
Nowlen TT, Rosenthal GL, Johson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002;110:137-42.  Back to cited text no. 5
    

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Correspondence Address:
Gaurav Garg
Department of Pediatric Cardiology, Max Super Specialty Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.171409

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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