Risk Factors of Central Venous Catheter Leakage in Neonatal Intensive Care Unit

Young Duck Kim; Na Mi Lee; Su Yeong Kim; Dae Yong Yi; Sin Weon Yun; Soo Ahn Chae; In Seok Lim

doi:10.14734/PN.2019.30.2.60

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Kim, Lee, Kim, Yi, Yun, Chae, and Lim: Risk Factors of Central Venous Catheter Leakage in Neonatal Intensive Care Unit

Original Article

Perinatology 2019;30(2):60-65.

Published online: 4 June 2019

DOI: https://doi.org/10.14734/PN.2019.30.2.60

Risk Factors of Central Venous Catheter Leakage in Neonatal Intensive Care Unit

Young Duck Kim, MD, Na Mi Lee, MD, PhD, Su Yeong Kim, MD, Dae Yong Yi, MD, PhD, Sin Weon Yun, MD, PhD, Soo Ahn Chae, MD, PhD, In Seok Lim, MD, PhD

Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea

Correspondence to Na Mi Lee, MD, PhD Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-6299-3181 Fax: +82-2-6264-2167 E-mail: piena81@caumc.or.kr

Received 22 August 2018 Revised 10 October 2018 Accepted 24 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Leakage of central venous catheter in neonatal intensive care unit (NICU) is a serious complication that can lead to death. The purpose of this study was to identify the clinical signs of central venous catheter leakage, with related risk factors and to establish preventive measures.

Methods

This was a retrospective study of neonates admitted to the NICU between March 2012 and March 2017. Medical records and imaging were reviewed for clinical course and risk factors.

Results

Total 603 neonates with central venous catheter were enrolled. Through fluid analysis, a total of 8 central venous leakages were identified (incidence 1.3%, 5 pericardial effusions, 1 pleural effusion, 2 ascites). After an average of 66.3 hours, leakage occurred from central venous catheterization. The mean volume of leakage fluid was 23.2 mL, and all culture studies were negative. Clinical manifestations related to leakage of patients with ascites were mild compared to pericardial effusion or pleural effusion. There was no recurrence after removal of the central vein catheter.

Conclusion

Central venous catheter leak should be suspected if sudden and/or marked change in the vital signs of neonates was identified after central venous catheterization. The multicenter study involving more patients will be necessary to identify risk factors for leakage.

Keywords: Central venous catheters, Infant, newborn, Pericardial effusion, Pleural effusion

References

1. Rodrigues AF, van Mourik ID, Sharif K, Barron DJ, de Giovanni JV, Bennett J, et al. Management of end-stage central venous access in children referred for possible small bowel transplantation. J Pediatr Gastroenterol Nutr. 2006; 42:427–33.

2. Azizkhan RG, Taylor LA, Jaques PF, Mauro MA, Lacey SR. Percutaneous translumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children. J Pediatr Surg. 1992; 27:165–9.

3. Traen M, Schepens E, Laroche S, van Overmeire B. Cardiac tamponade and pericardial effusion due to venous umbilical catheterization. Acta Paediatr. 2005; 94:626–8.

4. Booth SA, Norton B, Mulvey DA. Central venous catheterization and fatal cardiac tamponade. Br J Anaesth. 2001; 87:298–302.

5. Gravenstein N, Blackshear RH. In vitro evaluation of relative perforating potential of central venous catheters: comparison of materials, selected models, number of lumens, and angles of incidence to simulated membrane. J Clin Monit. 1991; 7:1–6.

6. Orme RM, McSwiney MM, Chamberlain-Webber RF. Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: a case report and review of the literature. Br J Anaesth. 2007; 99:384–8.

7. Beardsall K, White DK, Pinto EM, Kelsall AW. Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem? Arch Dis Child Fetal Neonatal Ed. 2003; 88:F292–5.

8. Nadroo AM, Glass RB, Lin J, Green RS, Holzman IR. Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics. 2002; 110:131–6.

9. Department of Health. Review of four neonatal deaths due to cardiac tamponade associated with the presence of a central venous catheter. London: Great Britain, Department of Health;2001. p. 6–15.

10. Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics. 2002; 110:137–42.

11. Chock VY. Therapeutic techniques: peripherally inserted central catheters in neonates. NeoReviews. 2004; 5:61–2.

12. Pezzati M, Filippi L, Chiti G, Dani C, Rossi S, Bertini G, et al. Central venous catheters and cardiac tamponade in preterm infants. Intensive Care Med. 2004; 30:2253–6.

13. Racadio JM, Doellman DA, Johnson ND, Bean JA, Jacobs BR. Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics. 2001; 107:e28.

14. Jouvencel P, Tourneux P, Pérez T, Sauret A, Nelson JR, Brissaud O, et al. Central catheters and pericardial effusion: results of a multicentric retrospective study. Arch Pediatr. 2005; 12:1456–61.

15. Rastogi S, Bhutada A, Sahni R, Berdon WE, Wung JT. Spontaneous correction of the malpositioned percutaneous central venous line in infants. Pediatr Radiol. 1998; 28:694–6.

16. Nadroo AM, al-Sowailem AM. Extravasation of parenteral alimentation fluid into the renal pelvis–a complication of central venous catheter in a neonate. J Perinatol. 2001; 21:465–6.

17. Khilnani P, Toce S, Reddy R. Mechanical complications from very small percutaneous central venous Silastic catheters. Crit Care Med. 1990; 18:1477–8.

18. Pigna A, Bachiocco V, Fae M, Cuppini F. Peripherally inserted central venous catheters in preterm newborns: two unusual complications. Paediatr Anaesth. 2004; 14:184–7.

19. Madhavi P, Jameson R, Robinson MJ. Unilateral pleural effusion complicating central venous catheterisation. Arch Dis Child Fetal Neonatal Ed. 2000; 82:F248–9.

20. Guzoglu N, Erdeve O, Yilmaz Y, Dilmen U. Intraperitoneal extravasation from umbilical venous catheter in differential diagnosis of neonatal chylous ascites. Acta Paediatr. 2010; 99:1284.

21. Shareena I, Khu YS, Cheah FC. Intraperitoneal extravasation of total parental nutrition infusate from an umbilical venous catheter. Singapore Med J. 2008; 49:e35–6.

Table 1.

Clinical Data of the Patients

Case	Sex G	Gestational age (weeks+day)	Birth weight (g)	Delivery type	Apgar scor (1/5 min)	Effusion site	Central line type	sertion perio (hours)	Insertion vein	Fluid rate (mL/hr)	Fluid glucose (%)
1	M	30+4	1,490	C/S	5/7	Ascite	PICC	216	Lt. saphenous	7.9	12.0
2	F	33+5	1,860	C/S	7/8	Pericardiac	PICC	72	Rt. cephalic	6.2	5.0
3	M	28+6	1,050	C/S	3/7	Pericardiac	PICC	48	Lt. cephalic	4.4	10.0
4	F	30+3	1,462	NSVD	8/9	Pleural	PICC	96	Rt. cephalic	7.6	10.0
5	M	36+1	2,192	C/S	9/10	Pericardiac	PICC	1	Rt. cephalic	9.1	10.0
6	M	40+0	3,940	NSVD	–/-	Pericardiac	UVC	72	Umbilical	13.1	10.0
7	F	27+5	1,160	NSVD	–/-	Ascite	PICC	1	Lt. cephalic	7.4	12.0
8	M	28+2	1,280	C/S	–/-	Pericardiac	PICC	24	Lt. axillary	9.2	12.0

Abbreviations: M, male; F, female; C/S, cesarean section; PICC, peripherally inserted central catheter; Lt., left; Rt., right; NSVD, normal spontaneous vaginal delivery; UVC, umbilical venous catheterization

Table 2.

Laboratory Findings of Aspirated Fluid

Case	Aspiration volume (mL)	Density	RBC (mm³)	WBC (mm³)	Protein (g/dL)	Glucose (mg/dL)	LDH (IU/L)	TG (mg/dL)	Culture study
1	–	1.02	500	1,800	5.1	362	345	1,734	N
2	10	1.01	130	80	2.2	665	40	501	N
3	7.5	1.01	9	3	0.3	2,705	43	167	N
4	46	1.01	2,730	8	0.3	489	45	–	N
5	15	1.02	160	0	0.4	3,550	6	795	N
6	40	1.01	550	580	<1.1	7,026	26	806	N
7	30	1.01	220	210	1.4	372	2,367	464	N
8	14	1.01	400	20	0.5	537	32	684	N

Abbreviations: RBC, red blood cells; WBC, white blood cells; LDH, Lactate dehydrogenase; TG, triglycerides; N, No.

Table 3.

Summary of Clinical Course of the Patients

Case	Clinical sign		Duration from first sign to diagnosis (hours)	Treatment	Expire
1	Abdominal distention, hypotension	Abdominal skin color change	8	Abdominal paracentesis	N
				Central-line remove
2	Sudden tachycardia, whole body cyanosis,	Sudden acidosis	4	Pericardiocenthesis	N
	chest wall retraction	Respiratory Failure		Ventilator care
				Central-line remove
3	Sudden bradycardia, respiratory failure	Whole body cyanosis	Within 1 hour	Cardiac massage	Y
		Hypotension		Pericardiocenthesis
				Ventilator care
				Central-line remove
4	Chest wall retraction, whole body cyanosis	Tachypnea	2	O2 inhalation	N
				Thoracentesis
				Central-line remove
5	Sudden bradycardia, respiratory failure	Whole body cyanosis	Within 1 hour	Cardiac massage	N
				Pericardiocenthesis
				Ventilator care
				Central-line remove
6	Sudden tachycardia, whole body cyanosis,	Sudden acidosis	6	Pericardiocenthesis	N
	whole body mottled skin	Respiratory Failure		Central-line remove
7	Abdominal distention	High HS-CRP	Within 1 hour	Abdominal paracentesis	N
				Central-line remove
8	Sudden bradycardia, respiratory failure	Whole body cyanosis	Within 1 hour	Pericardiocenthesis	N
				Ventilator care
				Central-line remove

Abbreviations: N, No; Y, Yes; HS-CRP, high sensitivity C-reactive protein.

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