背景:尽管使用外周插入的中央导管(PICC)具有许多优点,错位可导致严重的危及生命的并发症,如心包积液(PCE)和心包填塞(CT)。本报告旨在描述四例由于PICC错位导致的CT,成功管理。
方法:对胡志明市2号儿童医院的新生儿重症监护病房(NICU)中需要插入PICC并患有PCE导致CT的新生儿进行回顾性分析,越南,在2022年。
结果:四例涉及28-30周胎龄早产儿,重量在900-1,500克之间。PCE/CT在PICC插入后3至24天之间发展。突然发作并表现为血流动力学不稳定的临床表现包括突然恶化,嗜睡,呼吸暂停,心动过缓,苍白的皮肤,和心血管崩溃。我们使用心脏护理点超声(POCUS)来评估这些患者的病情并指导心包穿刺术。对用于PCE/CT治疗的抽吸液的分析与肠外营养的成分一致。没有遇到死亡。
结论:PICC插入后出现突然恶化的新生儿应进行POCUS以提示PCE/CT的识别。及时通过POCUS诊断,即时心包穿刺术,预防PICC错位相关的严重并发症至关重要.建议每周两次监测PICC位置以避免危及生命的并发症。此外,在目前的方案中,应考虑结合POCUS来识别PICC尖端,而不是仅仅依靠X射线.
BACKGROUND: Although the use of peripherally inserted central catheters (PICCs) has many advantages, misplacement can lead to serious life-threatening complications such as pericardial effusion (PCE) and cardiac tamponade (CT). This report aims to describe four cases of CT resulting from misplaced PICC, which were successfully managed.
METHODS: Retrospective analysis of neonates who required PICC insertion and had PCE leading to CT in the Neonatal Intensive Care Unit (NICU) at The Children\'s Hospital 2, Ho Chi Minh City, Vietnam, during the year 2022.
RESULTS: Four cases involved preterm infants at 28-30 weeks gestational age, weighing between 900-1,500 grams. The PCE/CT developed between 3 and 24 days following PICC insertion. The abrupt onset with clinical manifestations that showed hemodynamic instability included sudden deterioration, lethargy, apnea, bradycardia, pale skin, and cardiovascular collapse. We use cardiac point of care ultrasound (POCUS) to assess the condition of these patients and guide the pericardiocentesis procedure. The analysis of the aspirated fluid used for PCE/CT treatment is consistent with the component of parenteral nutrition. No deaths were encountered.
CONCLUSIONS: Neonates presenting sudden deterioration following PICC insertion should undergo POCUS to prompt identifying PCE/CT. Timely diagnosis via POCUS, prompt pericardiocentesis, and prevention of misplaced PICC-associated serious complications are crucial. Monitoring of the PICC position twice a week is recommended to avoid life-threatening complications. Additionally, incorporating POCUS for identifying the tip of PICC rather than relying solely on X-ray should be considered in the current protocol.