Retained central venous lines in the newborn: report of one case and systematic review of the literature.
The use of percutaneously inserted central catheters (PICCs) is an established practice in most NICUs. With the widespread use of these catheters, an increasing number of PICC complications has been reported in neonates. We present one case of a PICC retained and tethered in the vein in a very low birth weight infant, as well as a systematic review of PICC retention cases. Ten previous cases of PICC retention in neonates were found. Among those cases, the most common associated factors were coagulase-negative staphylococcus catheter colonization/bactcremia and long duration of catheterization. Occlusion was not a usefiul sign for predicting catheter retention. Once retention was established, heparin or urokinase instillations were ineffective. Although surgical exploration was sometimes required, firm, continuous traction applied to the catheter over several hours or intermittent, moderately strong pulling maneuvers were successful in 44.4 percent of the cases in which they were performed. Traction did not show major side effects. Our case provides additional support for use of traction as the initial approach in the management of this rare complication.
Serrano
Mercedes
M
Division of Neonatology, Hospital Universitario Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. mserrano@hsjdbcn.org
García-Alix
Alfredo
A
López
Juan-Carlos
JC
Pérez
Jesús
J
Quero
José
J
D000925:Anticoagulants / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000451:nursing; D004868:Equipment Failure; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007322:Instillation, Drug; D015931:Intensive Care, Neonatal / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000451:nursing; D017283:Neonatal Nursing / Q000379:methods*; D009730:Nursing Assessment; D012307:Risk Factors; D013997:Time Factors; D014143:Traction; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D000925:Anticoagulants; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator