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Aspiration of parenteral nutrition -- a previously unreported complication of central venous access in an infant: a case report.

Jardine LA, Inglis GD, Davies MW - J Med Case Rep (2008)

Bottom Line: The central venous line was removed because of presumed extravasation.This complication may have been prevented by recognising that the tip of the catheter was not correctly placed.When catheters are in unusual positions it may be useful to obtain a second radiograph from a different angle or an ultrasound scan to confirm the positioning of the catheter tip.

View Article: PubMed Central - HTML - PubMed

Affiliation: Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Luke_Jardine@health.qld.gov.au

ABSTRACT

Introduction: The insertion of percutaneous central venous catheters is a common procedure in neonatal intensive care nurseries. Placement of the catheter tip in a large central vein is most desirable. Occasionally, due to difficult venous access, catheter tips are left in places that are less than ideal.

Case presentation: A female infant with a complicated gastroschisis developed signs of short bowel syndrome post surgery. She was treated with a combination of parenteral nutrition and enteral feeds. A central venous line was inserted through a scalp vein. The tip was noted to be in a vessel at the level of the mandible. She subsequently became unwell with large milky pharyngeal aspirates and episodes of bradycardia. Chest radiography revealed aspiration. The central venous line was removed because of presumed extravasation. This is the first reported case of parenteral nutrition extravasation into the pharynx causing aspiration in an infant.

Conclusion: This complication may have been prevented by recognising that the tip of the catheter was not correctly placed. When catheters are in unusual positions it may be useful to obtain a second radiograph from a different angle or an ultrasound scan to confirm the positioning of the catheter tip.

No MeSH data available.


Related in: MedlinePlus

Radiograph post peripherally inserted central venous line insertion.
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Figure 1: Radiograph post peripherally inserted central venous line insertion.

Mentions: On day 67 of life, because of short bowel syndrome and intolerance of full enteral feeds of a semi-elemental formula, she was recommenced on parenteral nutrition (120 mL/kg/day) with some nasogastric feeds (60 mL/kg/day). Venous access was extremely difficult to obtain and after two different attempts a 24 French peripherally inserted central venous line (Neocath®, Vygon, Ecouen) was inserted through a right sided scalp vein. Blood was easily aspirated from the line at the time of insertion. As per our usual practice, the central venous catheter was slowly injected with 0.5 mL of Isovue 300 (Isovue® 300, Regional Health Care Products Group Medi-Consumabales Pty Ltd, Rosebery) and a radiograph was taken while injecting the dye (Figure 1) [1]. The tip was noted to be in a vessel at the level of the mandible and was deemed to be satisfactory for the infusion of parenteral nutrition. The Radiologists report stated the catheter tip location as the "internal jugular vein".


Aspiration of parenteral nutrition -- a previously unreported complication of central venous access in an infant: a case report.

Jardine LA, Inglis GD, Davies MW - J Med Case Rep (2008)

Radiograph post peripherally inserted central venous line insertion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2266767&req=5

Figure 1: Radiograph post peripherally inserted central venous line insertion.
Mentions: On day 67 of life, because of short bowel syndrome and intolerance of full enteral feeds of a semi-elemental formula, she was recommenced on parenteral nutrition (120 mL/kg/day) with some nasogastric feeds (60 mL/kg/day). Venous access was extremely difficult to obtain and after two different attempts a 24 French peripherally inserted central venous line (Neocath®, Vygon, Ecouen) was inserted through a right sided scalp vein. Blood was easily aspirated from the line at the time of insertion. As per our usual practice, the central venous catheter was slowly injected with 0.5 mL of Isovue 300 (Isovue® 300, Regional Health Care Products Group Medi-Consumabales Pty Ltd, Rosebery) and a radiograph was taken while injecting the dye (Figure 1) [1]. The tip was noted to be in a vessel at the level of the mandible and was deemed to be satisfactory for the infusion of parenteral nutrition. The Radiologists report stated the catheter tip location as the "internal jugular vein".

Bottom Line: The central venous line was removed because of presumed extravasation.This complication may have been prevented by recognising that the tip of the catheter was not correctly placed.When catheters are in unusual positions it may be useful to obtain a second radiograph from a different angle or an ultrasound scan to confirm the positioning of the catheter tip.

View Article: PubMed Central - HTML - PubMed

Affiliation: Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Luke_Jardine@health.qld.gov.au

ABSTRACT

Introduction: The insertion of percutaneous central venous catheters is a common procedure in neonatal intensive care nurseries. Placement of the catheter tip in a large central vein is most desirable. Occasionally, due to difficult venous access, catheter tips are left in places that are less than ideal.

Case presentation: A female infant with a complicated gastroschisis developed signs of short bowel syndrome post surgery. She was treated with a combination of parenteral nutrition and enteral feeds. A central venous line was inserted through a scalp vein. The tip was noted to be in a vessel at the level of the mandible. She subsequently became unwell with large milky pharyngeal aspirates and episodes of bradycardia. Chest radiography revealed aspiration. The central venous line was removed because of presumed extravasation. This is the first reported case of parenteral nutrition extravasation into the pharynx causing aspiration in an infant.

Conclusion: This complication may have been prevented by recognising that the tip of the catheter was not correctly placed. When catheters are in unusual positions it may be useful to obtain a second radiograph from a different angle or an ultrasound scan to confirm the positioning of the catheter tip.

No MeSH data available.


Related in: MedlinePlus