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Case Reports
. 2018 Apr 17:2018:bcr2018224471.
doi: 10.1136/bcr-2018-224471.

A misplaced peripherally inserted central catheter presenting as contralateral pleural effusion

Jogender Kumar  1 , Sudeep K C  1 , Kanya Mukhopadhyay  1 , Somosri Ray  1
Affiliations
Case Reports

A misplaced peripherally inserted central catheter presenting as contralateral pleural effusion

Jogender Kumar et al. BMJ Case Rep. .

Abstract

A preterm neonate born at 27 weeks, with a birth weight of 555 g, was on continuous positive airway pressure (CPAP) for apnoea of prematurity and initially received total parenteral nutrition (TPN) through the umbilical venous catheter. Peripherally inserted central catheter (PICC) was inserted in the left basilica vein on day 8 to continue TPN. The baby developed respiratory distress with persistent hypoxia after TPN was initiated through the PICC line. The baby required mechanical ventilation due to worsening of respiratory distress, and chest X-ray, as well as ultrasound conducted 12 hours, postinfusion of TPN revealed right-sided pleural effusion. On careful observation, we could trace the PICC in the right lung area. The PICC line was removed immediately and the baby improved over the next 18 hours and was extubated to CPAP within the next 48 hours. We report this case of contralateral pleural effusion secondary to malposition of PICC line in an extremely preterm neonate.

Keywords: neonatal and paediatric intensive care; neonatal intensive care; nutrition; parenteral / enteral feeding.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
First chest radiograph after placement of the peripherally inserted central catheter. The course of the catheter can be visualised until the left axillary region pointed out with the arrow.
Figure 2
Figure 2
Chest radiograph after clinical deterioration shows diffuse haziness in the right lung along with obliteration of cardiophrenic angle (arrows showing endotracheal tube and PICC line). PICC, peripherally inserted central catheter.
Figure 3
Figure 3
Chest radiograph (focused and zoomed) showing the course of the PICC line (marked with arrows). PICC, Peripherally inserted central catheter.
Figure 4
Figure 4
Chest radiograph obtained 24 hours after removal of the PICC line shows rapid resolution of haziness in the right lung. PICC, peripherally inserted central catheter.
See this image and copyright information in PMC

References

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