title: [Iatrogenic pleuropneumonia complicating central venous cannulation in a very low birth weight infant].
abstract: BACKGROUND
  Central venous cannulation is necessary for long-term parenteral nutrition in premature infants. Peripherally inserted long catheters are commonly used in these patients but even this relatively simple technique can end in serious complications. We present a case in which perforation of the vena cava and migration of the catheter to the intrapleural space resulted in multiple organ failure and death.
  
  
  METHODS
  A 700 g bw. infant, born at 28 weeks of gestation, was referred to our centre because of suspected bowel perforation. In the referring hospital, the infant had a central venous catheter inserted peripherally. The catheter migrated to the right intrapleural space, and parenteral formula was delivered over several hours to the right pleura, resulting in hydrothorax with serious compression of the lung and atelectasis. Emergency laparotomy did not reveal any pathology and a chest tube was inserted into the right pleura; the effusion fluid contained a large number fat particles. The child's condition worsened and he died 16 days after surgery because of multiple organ failure and sepsis.
  
  
  CONCLUSIONS
  Accidental migrations of central venous catheters to the pleural space have been described by many authors. It can result in severe pneumonia, cardiac tamponade or sepsis and is often fatal. We conclude that central venous catheters in premature infants should be inserted under ultrasonography or fluoroscopy. Catheters should never be forced along vessels; their size ought to be adjusted to age, and a free outflow of blood should be obtained before they are used.
authors.affiliation: Klinik Anestezjologii i Intensywnej Terapii, Collegium Medicum UMK w Bydgoszczy. kikanest@cm.umk.pl
authors.forename: Marlena
authors.initials: M
authors.lastname: Jakubczyk
authors.forename: Magdalena
authors.initials: M
authors.lastname: Chrzanowska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Apanasiewicz
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Chrupek
authors.forename: Roman
authors.initials: R
authors.lastname: Kaźmirczuk
authors.forename: Marika
authors.initials: M
authors.lastname: Reszczyńska
authors.forename: Andrzej I
authors.initials: AI
authors.lastname: Prokurat
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Szkulmowski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kusza
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D017809:Fatal Outcome; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D006876:Hydrothorax / Q000209:etiology; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology*; D010288:Parenteral Nutrition / Q000009:adverse effects; D010994:Pleura; D011001:Pleuropneumonia / Q000209:etiology*