Neonatal pericardial effusion/cardiac tamponade related to peripherally inserted central catheters: two case reports and literature review
10.3760/cma.j.cn113903-20230910-00191
- VernacularTitle:经外周静脉穿刺中心静脉置管相关新生儿心包积液/心脏填塞2例并文献复习
- Author:
Yucen LIU
1
;
Maojun LI
;
Wei SHI
;
Binzhi TANG
Author Information
1. 四川省医学科学院·四川省人民医院（电子科技大学附属医院）儿科，成都 610072
- Keywords:
Cardiac tamponade;
Pericardial effusion;
Peripherally inserted central catheter;
Infant, newborn;
Infant, low birth weight
- From:
Chinese Journal of Perinatal Medicine
2024;27(8):674-679
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To examine the clinical characteristics, treatment, and prognosis of peripherally inserted central catheter (PICC)-related pericardial effusion/cardiac tamponade in neonates.Methods:A retrospective analysis was conducted on the clinical data of two neonates with PICC-related pericardial effusion/cardiac tamponade admitted to Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (School of Medicine, University of Electronic Science and Technology of China) between October 2019 and February 2021. Literature was searched using keywords "peripherally inserted central catheter", "central venous catheter", "deep venous catheter", "pericardial effusion", "cardiac tamponade", and "neonate" in databases including CNKI, Wanfang, Yiigle, VIP Database, PubMed, Web of Science, and Embase databases up to June 2023. Clinical characteristics, treatment, and prognosis of neonates with PICC-related pericardial effusion/cardiac tamponade were summarized. Descriptive statistical analysis was used, and Fisher's exact test was employed to compare the impact of different treatment methods on the prognosis of the infants.Results:(1) Case report: Both infants experienced sudden onset of decreased heart rate and oxygen saturation, respiratory distress, pallor, and cyanosis of the lips. Case 1 did not undergo pericardiocentesis, while Case 2 did. Both infants died. (2) Literature review: A total of 25 articles (six in Chinese and 19 in English) were retrieved, involving 45 infants. Including the two cases from our institution, there were 47 infants in total. Among the 47 infants, 44 (94%) were preterm, and three (6%) were full-term. The gestational age of 46 infants was (29.5±3.9) weeks, with one full-term infant not reporting a specific gestational age. The birth weight of 46 infants was (1 227±600) g, with 43 (91%) being low birth weight infants. Nine cases (19%) did not specify the insertion site; 32 cases (68%) had the catheter inserted from the upper limb and six cases (13%) from the lower limb. After the onset of pericardial effusion/cardiac tamponade symptoms, the catheter tip was located at or near the right atrium in 26 cases (55%), at the junction of the vena cava and right atrium in three cases (6%), within the pericardial cavity or cardiac silhouette in three cases (6%), in the superior vena cava in two cases (4%), in the pulmonary artery in one case (2%), in the left atrium in one case (2.1%), and in the right ventricle in one case (2%). Ten cases (21%) did not specify the exact location. Among the 47 cases, 13 (28%) experienced catheter migration, and 11 (23%) had catheter kinking or angulation. Thirty cases (64%) underwent pericardiocentesis, one case (2%) underwent pericardiotomy, and 16 cases (34%) received conservative treatment. The cure rate in the non-conservative treatment group (pericardiocentesis or pericardiotomy) was 81% (25/31), higher than that in the conservative treatment group (6/16) (Fisher's exact test, P=0.004). Conclusion:Once sudden hemodynamic or respiratory abnormalities occur, cardiac ultrasound should be promptly performed to confirm the diagnosis, and pericardiocentesis should be timely conducted to improve the survival rate of the neonates.
