Cardiac Tamponade Due to Pericardial Effusion Following Peripherally Inserted Central Catheter: A Single-Institution Case Series

Abstract

Introduction: 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.

Conclusion: 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.

Keywords: cardiac tamponade; pericardial effusion; peripherally inserted central catheters; point-of-care ultrasound; shock.

Figure 1. Echocardiogram and chest radiograph of Case 1

a) Supine chest radiograph following PICC insertion, the catheter tip was not visualized; b) PCE; c) PICC tip positioned within the right atrium; d) PICC tip located at the junction of the superior vena cava and the right atrium after the catheter was withdrawn. PICC: Peripherally inserted central catheter; PCE: Pericardial effusion

Figure 2. Echocardiogram, chest radiograph, and pericardial fluid of Case 2

a) Chest X-ray performed in a supine position to confirm the PICC position but unable to reveal catheter tip position; b) PCE; c) Pericardiocentesis PICC: Peripherally inserted central catheter; PCE: Pericardial effusion

Figure 3. Echocardiogram and chest radiograph of Case 3

a) Chest X-ray performed in a supine position to confirm the PICC position but unable to reveal catheter tip position; b) PCE with the PICC tip within the right atrium; c) PICC tip within located the right atrium PICC: Peripherally inserted central catheter; PCE: Pericardial effusion

Figure 4. Echocardiogram and chest radiograph of Case 4

Echocardiogram showing PCE with CT PCE: Pericardial effusion; CT: Cardiac tamponade