Evaluation of Mechanical Complications During Pediatric Central Venous Catheter Placement from 1994 to 2013
Keywords:
Pediatrics, Central venous catheters, Complication, Cardiac tamponade.Abstract
Pediatric central venous catheter placement could be associated with mechanical complications. Knowledge of detailed information described in case reports on such mechanical complications can help improve patient safety. Through an extensive literature search for case reports in PubMed and other databases from 1994 to 2013, 86 cases (from 63 articles) of mechanical complications related to pediatric central venous catheter placement were identified. Of the 86 patients, 22 died: 16 had tamponade; 3 had malposition, including migration, extravasation, and dislodgement; 1 had arterial puncture; 1 had hemothorax; and 1 had cardiac perforation. Cardiac tamponade was reported more frequently when umbilical catheters were used (23 cases) compared to cases where catheters were inserted at 13 other sites. Most of the cases of cardiac tamponade appeared to be related to the location of the catheter tip in the right atrium. Mechanical complications may lead to life-threatening outcomes. Therefore, the location of the tip of the central venous catheter should be assessed immediately after insertion, particularly in neonates, and any signs of abnormality should be identified as soon as possible to ensure appropriate management. Thus, we believe that awareness of the details of case reports on mechanical complications related to central venous catheter placement in children could help reduce the unfavorable outcomes.
References
Mitto P, Barankay A, Späth P, Kunkel R, Richter JA. Central venous catheterization in infants and children with congenital heart diseases: experiences with 500 consecutive catheter placements. Pediatr Cardiol 1992; 13(1): 14-19.
Casado-Flores J, Barja J, Martino R, Serrano A, Valdivielso A. Complications of central venous catheterization in critically ill children. Pediatr Crit Care Med 2001; 2(1): 57-62. http://dx.doi.org/10.1097/00130478-200101000-00012
Cartwright DW. Central venous lines in neonates: a study of 2186 catheters. Arch Dis Child Fetal Neonatal Ed 2004; 89(6): F504-8. http://dx.doi.org/10.1136/adc.2004.049189
Karapinar B, Cura A. Complications of central venous catheterization in critically ill children. Pediatr Int 2007; 49(5): 593-9. http://dx.doi.org/10.1111/j.1442-200X.2007.02407.x
Askegard-Giesmann JR, Caniano DA, Kenney BD. Rare but serious complications of central line insertion. Semin Pediatr Surg 2009; 18(2): 73-83. http://dx.doi.org/10.1053/j.sempedsurg.2009.02.003
Costello JM, Clapper TC, Wypij D. Minimizing complications associated with percutaneous central venous catheter placement in children: recent advances. Pediatr Crit Care Med 2013; 14(2): 273-83. http://dx.doi.org/10.1097/PCC.0b013e318272009b
Alderson PJ, Burrows FA, Stemp LI, Holtby HM. Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients. Br J Anaesth 1993; 70(2): 145-8. http://dx.doi.org/10.1093/bja/70.2.145
Kayashima K, Fukutome. A reliable method for internal jugular vein catheterization for neonates and infants using a small-caliber Doppler probe. Masui 1996; 45(11): 1424-9.
Cherng YG, Cheng YJ, Chen TG, Wang CM, Liu CC. Cardiac tamponade in an infant. A rare complication of central venous catheterisation. Anaesthesia 1994; 49(12): 1052-4. http://dx.doi.org/10.1111/j.1365-2044.1994.tb04354.x
Chang LY, Horng YC, Chou YH, Tsou KI. Umbilical venous line related pericardial effusion in a premature neonate: report of a case. J Formos Med Assoc 1995; 94(6): 355-7.
van Engelenburg KC, Festen C. Cardiac tamponade: a rare but life-threatening complication of central venous catheters in children. J Pediatr Surg 1998; 33(12): 1822-4. http://dx.doi.org/10.1016/S0022-3468(98)90296-2
Jacobson Z, Strom J. Pericardial tamponade complicating central venous catheterization in an infant with very low birth weight: the role of echocardiography in diagnosis and treatment. Heart Dis 1999; 1(3): 133-5.
Pesce C, Mercurella A, Musi L, Campobasso P, Negri M. Fatal cardiac tamponade as a late complication of central venous catheterization: a case report. Eur J Pediatr Surg 1999; 9(2): 113-5. http://dx.doi.org/10.1055/s-2008-1072224
Darling JC, Newell SJ, Mohamdee O, Uzun O, Cullinane CJ, Dear PR. Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol 2001; 21(7): 461-4. http://dx.doi.org/10.1038/sj.jp.7210541
Lun KS, Lee WH. Cardiac tamponade secondary to umbilical vein catheterization in a premature newborn: a case report. HK J Paediatr 2002; 7: 98-100.
Madhok AB, Chabbra M, Lourdes C. Unusual complication of umbilical venous catheterization leads to pericardial tamponade. Internet J Pediatr Neonat 2002; 2(2).
Onal EE, Saygili A, Koç E, Türkyilmaz C, Okumus N, et al. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe? Paediatr Anaesth 2004; 14(11): 953-6. http://dx.doi.org/10.1111/j.1460-9592.2004.01385.x
Traen M, Schepens E, Laroche S, van Overmeire B. Cardiac tamponade and pericardial effusion due to venous umbilical catheterization. Acta Paediatr 2005; 94(5): 626-8. http://dx.doi.org/10.1080/08035250410025492
Al Nemri AM, Ignacio LC, Al Zamil FA, Al Jarallah AS. Rare but fatal complication of umbilical venous catheterization. Congenit Heart Dis 2006; 1(4): 180-3. http://dx.doi.org/10.1111/j.1747-0803.2006.00031.x
Norris ML, Klaassen R. Central venous catheter thrombosis as a cause of SVC obstruction and cardiac tamponade in a patient with Diamond-Blackfan anemia and iron overload. Pediatr Blood Cancer 2006; 46(1): 112-4. http://dx.doi.org/10.1002/pbc.20368
Hong EJ, Lee KA, Bae IH, Kim MJ, Han HS. Umbilical venous line-related pleural and pericardial effusion causing cardiac tamponade in a premature neonate: A case report. Korean J Pediatr 2006; 49(6): 686-90. http://dx.doi.org/10.3345/kjp.2006.49.6.686
Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol 2007; 27(5): 317-9. http://dx.doi.org/10.1038/sj.jp.7211678
Monteiro AJ, Canale LS, Barbosa R, Méier M. Cardiac tamponade caused by central venous catheter in two newborns. Rev Bras Cir Cardiovasc 2008; 23(3): 422-4. http://dx.doi.org/10.1590/S0102-76382008000300023
Towbin R. The bowed catheter sign: a risk for pericardial tamponade. Pediatr Radiol 2008; 38(3): 331-5. http://dx.doi.org/10.1007/s00247-007-0674-z
Arya SO, Hiremath GM, Okonkwo KC, Pettersen MD. Central venous catheter-associated pericardial tamponade in a 6-day old: a case report. Int J Pediatr 2009; 2009: 910208.
Alabsi S. Neonatal cardiac tamponade and pleural effusion resolved with chest tube placement. Neonatal Netw 2010; 29(6): 347-51. http://dx.doi.org/10.1891/0730-0832.29.6.347
Megha M, Jain N, Pillai R. Pericardial tamponade in a newborn following umbilical catheter insertion. Indian Pediatr 2011; 48(5): 404-5.
Farry PM, Paterson A. Perforation into the pericardial sac of an infant: a rare complication of central venous catheter insertion. Ulster Med J 2012; 81(1): 50-1.
Abdellatif M, Ahmed A, Alsenaidi K. Cardiac tamponade due to umbilical venous catheter in the new born. BMJ Case Rep 2012; 13(7): 2012.
Warren M, Thompson KS, Popek EJ, Vogel H, Hicks J. Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization. Ann Clin Lab Sci 2013; 43(2): 163-71.
Currarino G. Migration of jugular or subclavian venous catheters into inferior tributaries of the brachiocephalic veins or into the azygos vein, with possible complications. Pediatr Radiol 1996; 26(7): 439-49. http://dx.doi.org/10.1007/BF01377198
Lussky RC, Trower N, Fisher D, Engel R, Cifuentes R. Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate. Am J Perinatol 1997; 14(2): 63-7. http://dx.doi.org/10.1055/s-2007-994099
Rajan V, Waffarn F. Focal neurological manifestations following aberrant central venous catheter placement. J Perinatol 1999; 19(6): 447-9. http://dx.doi.org/10.1038/sj.jp.7200207
Ghafoor AU, Mayhew JF, Gentry WB, Schmitz ML. Transpleural subclavian central venous catheter placement in a child with scoliosis discovered during a thoracotomy. J Clin Anesth 2003; 15(2): 142-4. http://dx.doi.org/10.1016/S0952-8180(02)00517-2
Anderson C, Graupman PC, Hall WA, Sweeny M, Lam CH. Pediatric intracranial complications of central venous catheter placement. Pediatr Neurosurg 2004; 40(1): 28-31. http://dx.doi.org/10.1159/000076574
Chambers NA. Left internal jugular catheter tip wedged in the left superior intercostal vein, an inferior tributary of the brachiocephalic. Paediatr Anaesth 2005; 15(11): 1022-3. http://dx.doi.org/10.1111/j.1460-9592.2005.01707.x
Costa S, De Carolis MP, Savarese I, Manzoni C, Lacerenza S, et al. An unusual complication of umbilical catheterisation. Eur J Pediatr 2008; 167(12): 1467-9. http://dx.doi.org/10.1007/s00431-008-0691-4
Yiiter M, Arda IS, Hiçsönmez A. Hepatic laceration because of malpositioning of the umbilical vein catheter: case report and literature review. J Pediatr Surg 2008; 43(5): E39-41. http://dx.doi.org/10.1016/j.jpedsurg.2008.01.018
Chhabra A, Pawar DK, Khanna P, Sokhal N. Intraoperative dislodgement of an internal jugular central line with an undisturbed skin fixation. Paediatr Anaesth 2008; 18(11): 1130-1. http://dx.doi.org/10.1111/j.1460-9592.2008.02640.x
Skinner TA, Mather SJ. Inadvertent extradural insertion of an internal jugular catheter in an infant. Br J Anaesth 1995; 75(6): 790-3. http://dx.doi.org/10.1093/bja/75.6.790
Miyamoto Y, Kinouchi K, Hiramatsu K, Kitamura S. Cervical dural puncture in a neonate: a rare complication of internal jugular venipuncture. Anesthesiology 1996; 84(5): 1239-42. http://dx.doi.org/10.1097/00000542-199605000-00028
Zenker M, Rupprecht T, Hofbeck M, Schmiedl N, Vetter V, et al. Paravertebral and intraspinal malposition of transfemoral central venous catheters in newborns. J Pediatr 2000; 136(6): 837-40.
Vidwans A, Neumann DP, Hussain N, Rosenkrantz T, Sanders MR. Diagnosis and management of spinal epidural space extravasation complicating percutaneous central venous line placement in a premature infant: case report and review of literature. Conn Med 2000; 64(2): 79-82.
Fujita Y, Sobue K, Hattori T, Takeuchi A, Tsuda T, et al. Inadvertent intrathecal cannulation in an infant, demonstrated by three-dimensional computed tomography: a rare complication of internal jugular vein catheterization. J Anesth 2006; 20(2): 122-5. http://dx.doi.org/10.1007/s00540-005-0383-4
Skeehan TM. Unusual central venous catheter placement in a patient with congenital heart disease. J Cardiothorac Vasc Anesth 1993; 7(2): 204-6. http://dx.doi.org/10.1016/1053-0770(93)90219-B
Cupitt JM. An unusual complication of a central venous catheter in a neonate. Paediatr Anaesth 2000; 10(6): 665-8.
Eulmesekian PG, Pérez A, Minces PG, Lobos P, Moldes J, et al. Internal mammary artery injury after central venous catheterization. Pediatr Crit Care Med 2007; 8(5): 489-91. http://dx.doi.org/10.1097/01.PCC.0000282850.25806.0A
Koklu E, Poyrazoglu H, Yikilmaz A, Canpolat M, Konuskan B. Subclavian artery pseudoaneurysm: a rare and serious complication of central venous catheterization in an infant. Pediatr Radiol 2008; 38(2): 220-3. http://dx.doi.org/10.1007/s00247-007-0630-y
Chan CC, Lee V, Chu W, Tam YH, Li CK, et al. Carotid jugular arteriovenous fistula: an unusual complication of internal jugular vein catheterization in children. Pediatr Blood Cancer 2012; 59(7): 1302-4. http://dx.doi.org/10.1002/pbc.24137
Kayashima K, Habe K. A case report of an accidental vertebral arterial puncture videotaped during central venous catheterization in a child undergoing a ventricular septal defect repair. Paediatr Anaesth 2012; 22(3): 311-2. http://dx.doi.org/10.1111/j.1460-9592.2011.03790.x
Kayashima K. An accidental puncture of a small artery behind the internal jugular vein in real-time ultrasound-guided pediatric central venous cannulation. Masui 2013; 62(2): 193- 6.
Lovell M, Baines D. Fatal complication from central venous cannulation in a paediatric liver transplant patient. Paediatr Anaesth 2000; 10(6): 661-4. http://dx.doi.org/10.1111/j.1460-9592.2000.00576.x
Hohlrieder M, Oberhammer R, Lorenz IH, Margreiter J, Kühbacher G, et al. Life-threatening mediastinal hematoma caused by extravascular infusion through a triple-lumen central venous catheter. Anesth Analg 2004; 99(1): 31-5. http://dx.doi.org/10.1213/01.ANE.0000117148.40842.CA
Waddington MS, Mullins GC. Early complication of pediatric central venous cannulation. Paediatr Anaesth 2005; 15(11): 1001-5. http://dx.doi.org/10.1111/j.1460-9592.2004.01560.x
Lu WH, Huang TC, Pan JY, Wang HP, Lin CC, et al. A potentially fatal complication during subclavian vein catheterization in an infant with congenital heart diseasepuncture to pulmonary artery directly: a case report. J Clin Anesth 2008; 20(3): 225-7. http://dx.doi.org/10.1016/j.jclinane.2007.10.012
Kurekci E, Kaye R, Koehler M. Chylothorax and chylopericardium: a complication of a central venous catheter. J Pediatr 1998; 132(6): 1064-6. http://dx.doi.org/10.1016/S0022-3476(98)70414-7
Alkayed K, Plautz G, Gowans K, Rosenthal G, Soldes O, et al. Chylopericardium and chylothorax: unusual mechanical complications of central venous catheters. Pediatr Int 2013; 55(2): e4-6. http://dx.doi.org/10.1111/j.1442-200X.2012.03701.x
Mupanemunda RH, Mackanjee HR. A life-threatening complication of percutaneous central venous catheters in neonates. Am J Dis Child 1992; 146(12): 1414-5.
Wang CC, Chen YW, Wu ET, Chien YH, Hwu WL, et al. Identification and management of cardiac perforation from a double lumen catheter in an infant. Paediatr Anaesth 2007; 17(5): 500-1. http://dx.doi.org/10.1111/j.1460-9592.2006.02142.x
Puvabanditsin S, Garrow E, Weerasethsiri R, Patel N, Davis SE, et al. Fracture of a Broviac catheter in a low-birth-weight infant. Hong Kong Med J 2008; 14(5): 411-3.
Tutar E, Aypar E, Atalay S, Yavuz G, Dou F. Percutaneous transcatheter retrieval of intracardiac central venous catheter fragments in two infants using Amplatz Goose Neck snare. Turk J Pediatr 2009; 51(5): 519-23.
Jiang ZM, Chen ZH, Zhong JF, Hu SY, Wu BY, et al. One case of guide wire fracture and retention in child’s internal jugular vein puncture. Chin Med J (Engl) 2012; 125(16): 2959-60.
Giretti R, Caruselli M, Zannini R, de Vivo E, Piattellini G, et al. Dislocation of central venous catheters in paediatric patients. J Vasc Access 2006; 7(3): 132-5.
Nuss R, Cole L, Le T, Orsini E, Harned R. Pinch-off syndrome in patients with sickle cell disease receiving erythrocytapheresis. Pediatr Blood Cancer 2008; 50(2): 354- 6. http://dx.doi.org/10.1002/pbc.21058
Caruselli M, Zannini R, Giretti R, Piattellini G, Bechi P, et al. The pinch-off syndrome in a pediatric patient. Paediatr Anaesth 2009; 19(3): 179-81. http://dx.doi.org/10.1111/j.1460-9592.2008.02689.x
Eryilmaz E, Canpolat C, Celiker A. Catheter fragment embolization: a rare yet serious complication of catheter use in pediatric oncology. Turk J Pediatr 2012; 54(3): 294-7.
Gowraiah V, Culham G, Chilvers MA, Yang CL. Embolization of a central venous catheter due to pinch-off syndrome. Acta Paediatr 2013; 102(2): e49-50. http://dx.doi.org/10.1111/apa.12085
Keohane M, Allen R. Persistent atrial fibrillation following central venous cannulation. Paediatr Anaesth 1999; 9(2): 178-9. http://dx.doi.org/10.1046/j.1460-9592.1999.00359.x
Cephus CE, Mott AR, Kertesz NJ, Slesnick TC. Transient complete atrioventricular block after placement of a central venous catheter in a neonate. Pediatr Crit Care Med 2007; 8(1): 64-6. http://dx.doi.org/10.1097/01.pcc.0000256618.78382.da
da Silva PS, Waisberg J. Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication. J Pediatr Surg 2010; 45(8): E13-6.
Ford S, Lauder G. Case report of Horner’s syndrome complicating internal jugular venous cannulation in a child. Paediatr Anaesth 2007; 17(4): 396-8. http://dx.doi.org/10.1111/j.1460-9592.2006.02107.x
Weil BR, Ladd AP, Yoder K. Pericardial effusion and cardiac tamponade associated with central venous catheters in children: an uncommon but serious and treatable condition. J Pediatr Surg 2010; 45(8): 1687-92. http://dx.doi.org/10.1016/j.jpedsurg.2009.11.006
Food and drug administration. Cardiac perforation and tamponade: The deadly duo of central venous catheter. FDA patient safety news: Show #1, February 2002. http://www.accessdata.fda.gov/psn/printer.cfm?id=119. (accessed, 28 August, 2013)
Nash P. Umbilical catheters, placement, and complication management. J Infus Nurs 2006; 29(6): 346-52. http://dx.doi.org/10.1097/00129804-200611000-00005
Yoon SZ, Shin JH, Hahn S, Oh AY, Kim HS, et al. Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients. Br J Anaesth 2005; 95(4): 514-7. http://dx.doi.org/10.1093/bja/aei199
Inagawa G, Ka K, Tanaka Y, Kato K, Tanaka M, et al. The carina is not a landmark for central venous catheter placement in neonates. Paediatr Anaesth 2007; 17(10): 968- 71. http://dx.doi.org/10.1111/j.1460-9592.2007.02258.x
Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002; 110(1): 137-42. http://dx.doi.org/10.1542/peds.110.1.137
Tsui BC, Richards GJ, Van Aerde J. Umbilical vein catheterization under electrocardiogram guidance. Paediatr Anaesth 2005; 15(4): 297-300. http://dx.doi.org/10.1111/j.1460-9592.2005.01433.x
Meola S, Galante D. The use of ultrasound guidance to avoid the pinch-off syndrome. Paediatr Anaesth 2009; 19(6): 631. http://dx.doi.org/10.1111/j.1460-9592.2009.03007.x
Knyazer B, Levy J, Rosenberg E, Lifshitz T, Lazar I. Horner’s syndrome in an infant with complicated pneumonia. Isr Med Assoc J 2011; 13(8): 504-6.
Lazar I, Cavari Y, Rosenberg E, Knyazer B. Horner’s syndrome in patients admitted to the paediatric intensive care unit: epidemiology, diagnosis and clinical practice. Anaesth Intensive Care 2013; 41(1): 20-3.
