title: Extravascular collection of fluid around the vertebra resulting from malpositioning of a peripherally inserted central venous catheter in extremely low birth weight infants.
abstract: Peripherally inserted central venous catheters (PICCs) have allowed central venous access via peripheral veins for a long period. PICCs have become an indispensable tool in neonatal medicine. Despite their benefits, PICCs involve some risks, which include infection, thrombosis, malpositioning, and extravascular collection of fluid. We presented two patients with extravascular collection of fluid around the vertebra resulting from malpositioning of PICCs. The PICCs were placed via the saphenous veins in both patients. The PICCs were judged to be centrally placed in the inferior vena cava by means of supine abdominal roentgenograms. The next day one patient exhibited frequent apneic attacks and the other exhibited twitching movements. A lumbar puncture revealed extravascular collection of fluid around the vertebra. In lateral view chest-abdominal roentgenograms, the PICC tips were observed to be in the vertebral lumen. The PICCs were removed immediately and the condition of the patients improved. We stressed the usefulness of the lateral view abdominal roentgenograms for revealing the malpositioning of PICCs in the inferior vena cava.
authors.affiliation: Division of Neonatal Intensive Care Unit, Perinatal Medical Center for Mothers and Children, Department of Pediatrics, Kyoto First Red Cross Hospital, Kyoto, Japan. nm1125@mbox.kyoto-inet.or.jp
authors.forename: Nobuto
authors.initials: N
authors.lastname: Mitsufuji
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsuo
authors.forename: Shizuyo
authors.initials: S
authors.lastname: Kakita
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Ikuta
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008159:Lumbar Vertebrae; D011247:Pregnancy; D014427:Twins