title: Iatrogenic acute cardiac tamponade during percutaneous removal of a fractured peripherally inserted central catheter in a premature neonate.
abstract: Acute cardiac tamponade (ACT) is a life-threatening complication associated with a peripherally inserted central catheter (PICC) in premature neonates. We present a case of ACT in a 4-day-old male infant. On the second admission day, a PICC was inserted. After 2.5 months, chest radiography showed PICC fracture, and its distal portion had migrated into the right pulmonary artery. Percutaneous removal through cardiac catheterization was attempted. However, right ventriculography demonstrated intrapericardial spillage of contrast agents, and iatrogenic ACT was confirmed. Cardiopulmonary resuscitation (CPR) was immediately started with open-chest cardiac massage. Further surgical exploration revealed right atrial appendage perforation. After 25-min CPR, the patient restored spontaneous circulation, and removal of the foreign bodies was performed. The post-operative course was uneventful. PICC fracture is an uncommon complication, but may be life-threatening. Precaution should be taken to avoid ACT during removal of a broken PICC. Once the tamponade is diagnosed, immediate interventions are mandatory.
authors.affiliation: Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Rd, Guangzhou 510623, PR China.
authors.forename: Zou
authors.initials: Z
authors.lastname: Minghui
authors.affiliation: Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Rd, Guangzhou 510623, PR China.
authors.forename: Cui
authors.initials: C
authors.lastname: Hujun
authors.affiliation: Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Rd, Guangzhou 510623, PR China.
authors.forename: Ma
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Rd, Guangzhou 510623, PR China.
authors.forename: Chen
authors.initials: C
authors.lastname: Weidan
authors.affiliation: Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Rd, Guangzhou 510623, PR China.
authors.forename: Cui
authors.initials: C
authors.lastname: Yanqin
authors.affiliation: Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Rd, Guangzhou 510623, PR China. Electronic address: zingerchen@126.com.
authors.forename: Chen
authors.initials: C
authors.lastname: Xinxin
mesh_terms: D000208:Acute Disease; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects*; D004868:Equipment Failure; D006801:Humans; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010492:Pericardiectomy; D015646:Ventriculography, First-Pass
keywords: Cardiac tamponade; Fracture; Iatrogenic; Neonate; Peripherally inserted central catheter