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Pericardial Effusion with a Properly Placed Umbilical Venous Catheter


Ahmad A. Aboaziza, MD; Darshan Shah, MD; Jennifer Gibson, MD; Otto H. Teixeira, MD

Introduction

Pericardial effusion caused by Umbilical Venous Catheter (UVC) is described with intracardiac location of the tip of the UVC. Mechanisms of injury range from direct myocardial perforation to thrombus formation and myocardial necrosis.


Case Presentation

A preterm, 27-week, appropriate-for-gestational age female was immediately transferred to the Neonatal Intensive Care Unit (NICU) after delivery due to prematurity and Respiratory Distress Syndrome (RDS). Her Apgar scores were 6 and 8 at 1 and 5 minutes, respectively.


A physical exam revealed an active preterm female in moderate respiratory distress with subcostal retractions. Vital signs included: a temperature of 100.9° F, a pulse 189bpm, respiratory rate 61bpm, blood pressure 57/27mmhg, and weight 1335g. On lung auscultation there were diffuse rhonchi over both lung fields. Mild hypotonia was present. The remainder of the exam was unremarkable.



FIGURE 1 Chest- X-ray (PA view) showing UVC and UAC line placements.



Umbilical artery and venous lines were placed upon arrival to the NICU. As demonstrated in Figure 1, the umbilical arterial catheter tip was located at the level of the T6, and the umbilical venous catheter tip projected at the cavoatrial junction.


On Day of Life (DOL) 1, an echocardiogram did not show any pericardial effusion.

Repeat imaging showed the arterial line with its tip at the T7 level and the venous line with its tip at the T6 level.


On DOL 3, an echo showed a small circumferential pericardial effusion. The X-ray showed 'optimal position' of the UVC. Echocardiograms failed to show the catheter tip in the heart on Day 1 or on Day 3. Ejection fraction was 91.7%. Clinically, the infant deteriorated and required intubation for worsening blood gas.


On DOL 4, a repeat echo showed a moderate circumferential pericardial effusion with no evidence of cardiac tamponade. The effusion was mainly located posteriorly, and was slightly larger compared to the previous day. Ejection fraction remained unchanged. In view of these findings, the umbilical lines were then removed, and a PICC line was placed.


On DOL 5, the pericardial effusion had decreased as the infant remained stable on vent support.


By DOL 7, there was no pericardial effusion seen on echocardiogram.


To read the full article, please go to the May 2016 Issue of CCT.