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      PICC tip dislodgement causing massive pleural effusion and atelectasis with acute respiratory failure: a case report

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          Abstract

          Peripheral intravenous central catheter (PICC) is a common tool for intravenous infusion for children who need central venous access. Although it is safe for physicians and nurses to place, complications like infection, occlusion, phlebitis, and bleeding can occur. We report a 5-month-old infant who suffered respiratory failure caused by catheter malposition resulting in massive fluid infusion into the thoracic cavity. Point-of-care ultrasound (POCUS) was utilized to identify a massive pleural effusion that prompted urgent drainage. Complications related to PICC in pediatric patients are not common but difficult to immediately identify sometimes. Therefore, careful attention should be paid by physicians to identify and reduce the risk of complications associated with PICC. Thus, visual tools are strongly advised to enhance the safety of invasive procedures.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12887-024-04856-2.

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          Most cited references24

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          Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations.

          U B Westergaard, V Classen, S Walther-Larsen (2013)
          Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search of the current literature. Although the literature is heterogeneous with few randomised studies, PICCs emerge as a safe and valuable option for intermediate- to long-term central venous access in children both in and out of hospital. Insertion can often be performed in light or no sedation, with little risk of perioperative complications. Assisted visualisation, preferably with ultrasound, yields high rates of insertion success. With good catheter care, rates of mechanical, infectious and thrombotic complications are low and compare favourably with those of traditional central venous catheters. Even in the case of occlusion or infection, fibrinolytics and antibiotic locks often allow the catheter to be retained.
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            Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters.

            V L Hoshal (1975)
            Long-term indwelling central venous catheters inserted peripherally for total intravenous nutrition have been complicated by thrombophlebitis in most instances. However, experiences with silicone elastomer catheters used in this manner have not been previously reported. In this investigation a crank introducer unit has been developed that has allowed 61-cm silicone elastomer catheters to be placed in the superior vena cava with insertion in the basillic or cephalic vein. Thirty-five patients (36 catheter placements) received total intravenous nutrition exclusively via these silicone elastomer catheters. The mean time indwelling was 20.4 days (range, four to 56 days). Thirty of the 36 catheters were removed when total intravenous nutrition was discontinued. Only six catheters were removed for nonvenous and venous reactions. These results have shown the safety and efficacy of peripherally inserted silicone elastomer central venous catheters.
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              Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review.

              Griffin Fearonce, Iris Faraklas, Jeffrey R Saffle … (2015)
              Central venous catheters (CVCs) are traditionally used for central venous access in the intensive care unit setting. Use of peripherally inserted central catheters (PICCs) now often extends into the intensive care unit. The goal of this review is to compare the use and safety of PICCs vs CVCs in burn patients. This institutional review board-approved cohort review included all burn patients at a single center who received one or more PICCs during a 2-year period. Primary outcome was number of days each line remained in place. Secondary outcomes were catheter-related bloodstream infection (CR-BSI) and thrombotic and technical complications. Thirty-one burn patients had 37 PICCs during the study period. Patients and controls were comparable in terms of age, TBSA burn injury, and ventilator days. The median length of time that each PICC remained in was 8.8 vs 9.3 days for CVCs (P = .77). The CR-BSI rate for PICCs was 0 per 1000 line days, whereas for CVCs, it was 6.6 per 1000 line days (P = .13). No thrombotic complications were attributed to CVCs; one PICC-associated right upper extremity deep vein thrombosis was identified (2.8% rate). No technical complications were identified in either group. The longevity and complications of PICCs in burn patients differs little from CVCs. CVCs may have a higher rate of CR-BSI in burn patients than PICCs. Although PICCs are not adequate for the fluid volumes typically required during burn shock resuscitation, they can provide a safe and effective alternative for central access in the ongoing care of the burn patient.
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                Author and article information

                Contributors
                Wanhong Yin: yinwanhong@wchscu.cn
                Journal
                Journal ID (nlm-ta): BMC Pediatr
                Journal ID (iso-abbrev): BMC Pediatr
                Title: BMC Pediatrics
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2431
                Publication date (Electronic): 10 July 2024
                Publication date PMC-release: 10 July 2024
                Publication date Collection: 2024
                Volume: 24
                Electronic Location Identifier: 441
                Affiliations
                [1 ]Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, ( https://ror.org/01v5mqw79) 169 Donghu Rd, Wuchang District, Wuhan, Hubei Province 430071 China
                [2 ]Department of Critical Care Medicine, West China Hospital of Sichuan University, ( https://ror.org/007mrxy13) No.37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041 China
                [3 ]Department of Cardiology, David Geffen School of Medicine, University of California Los Angeles, ( https://ror.org/046rm7j60) Los Angeles, CA 90095 USA
                Article
                Publisher ID: 4856
                DOI: 10.1186/s12887-024-04856-2
                PMC ID: 11234768
                PubMed ID: 38987700
                SO-VID: 936d74e3-5704-4a83-b706-575a4e85981b
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 7 October 2023
                Date accepted : 24 May 2024
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Pediatrics
                Keywords: pleural effusion,ultrasound,picc,case report
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: pleural effusion, ultrasound, picc, case report

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