Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review

Abstract

Background: Extremely premature infants have poor vascular conditions. Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters, and these vessels are often accompanied by arteries; thus, it is easy to mistakenly enter the artery.

Case summary: The case of an extremely premature infant (born at gestational age 28⁺³) in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported. On the 19^th day of hospitalization, the index finger, middle finger and ring finger of the left hand were rosy, the left radial artery and brachial artery pulse were palpable, the recovery was 95%, and the improvement was obvious. At discharge 42 d after admission, there was no abnormality in fingertip activity during the follow-up period.

Conclusion: Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2% nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb. Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.

Keywords: Anticoagulation; Arterial thrombosis; Case report; Nitroglycerin; Peripherally inserted central catheters.

Figure 1

The patient's chest X-ray film showed that the catheter was located on the left side of the spine (arrow).

Figure 2

The outcome of left finger-tip artery embolization. A: On admission, physical examination showed that the palm of the left hand was blue and purple, the left index finger, middle finger, and ring finger end knuckles were black, and the border was unclear. B, C: After a week, the left index finger, middle finger, and ring finger turned ruddy. D: On the 10^th day of admission, a yellow-like tissue of approximately 0.5 cm × 0.3 cm was visible on the fingertips. E: On the 13^th day of admission, the fingernail of the middle finger was off, with 0.3 cm × 0.5 cm yellow tissue visible at the fingertips. F: On the 19^th day of admission, the index finger, middle finger, ring finger of the left hand were rosy, and bruising was visible on the middle fingertips. No exudation or secretions were observed, the degree of recovery reached 95%, and the improvement was obvious.