Central venous catheters and cardiac tamponade in preterm infants.
OBJECTIVE
To determine the incidence of cardiac tamponade related to peripherally inserted central catheters in newborns weighing less than 1,500 g during the past 8 years and to provide guidelines in order to avoid death due to this complication.


METHODS
Retrospective case review.


METHODS
Tertiary level neonatal intensive care unit.


METHODS
Retrospective study of a total of 280 peripherally inserted central catheters positioned in 258 preterm newborns.


RESULTS
Five cardiac tamponades were observed, giving an incidence of 1.8%. Data from our cases included clinical presentation and outcome, biochemical evaluation of pericardial fluid, days until diagnosis, central catheters characteristics, insertion site and tip placement site.


METHODS
Two of the infants did not respond to resuscitation measures including cardiac massage and the administration of epinephrine. Post-mortem examination revealed the intrapericardial accumulation of protein and lipid alimentation solution. The other three patients were successfully resuscitated by timely pericardiocentesis. All five infants had routinely performed serial radiographs and cardiac color Doppler ultrasonography that showed correct catheter tip placement.


CONCLUSIONS
The incidence of cardiac tamponade could be reduced by following specific guidelines. The possibility of tamponade must be kept in mind during the resuscitation of any preterm infant with a peripherally inserted central catheter in place who develops symptoms of shock or sudden bradycardia. Our experience shows that even preterm infants with cardiac tamponade can be successfully resuscitated by timely pericardiocentesis in most cases.
Pezzati
Marco
M
Neonatal Intensive Care Unit, Department of Critical Care Medicine, Careggi University Hospital, Viale Morgagni 85, 50134 Florence, Italy.
Filippi
Luca
L
Chiti
Gianna
G
Dani
Carlo
C
Rossi
Sauro
S
Bertini
Giovanna
G
Rubaltelli
Firmino F
FF
D002305:Cardiac Tamponade / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D020519:Pericardiocentesis; D012189:Retrospective Studies