Journal Article

Delayed presentation of a malpositioned central venous access device (CVAD) in a neonate

Cullen, Terry, Atkin, Karen L, Zeman, Kiah, Armstrong, Ruth K

2024

Overview

Position was confirmed on a single antero-posterior (AP) abdominal radiograph per local practice, with projection of the tip adjacent to L4/L5 vertebrae at the level of the common iliac vein (figure 2). Table 1 Blood results Name Level Reference range Units pH 7.19 7.35–7.45 Carbon dioxide (CO2) 50 35–46 mm Hg Base excess −9 −2 to +3 mmol/L Bicarbonate (HCO3) 19 22–28 mmol/L Lactate 1.3 0.4–2 mmol/L Sodium (Na) 128 135–145 mmol/L On day 18, left leg and flank oedema evolved with difficulty infusing via the PICC line. While PICC lines deliver essential, lifesaving treatment to neonates, they also carry substantial risks.1 2 It is precisely because of these risks that so many national and regional centres have guidelines and frameworks of practice designed for clinicians who use central venous access devices (CVADs).3–7 PICCs inserted into the lower limbs should ideally thread without resistance, follow a smooth course without kinks or wiggles and sit to the right of the spine, above the level of the renal vessels at L2 but below the level of the cardiac silhouette at T9.1 4–6 On retrospective review, the single AP radiograph taken following insertion of the PICC line did not adhere to all of these principles, and the line malposition was not recognised. Central line Care- PICC insertion in the neonate. 2019.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Abdomen / Breastfeeding & lactation / Case reports / Catheters / Central Venous Catheters - adverse effects / Congenital disorders / Edema / Enteral nutrition / Fistula / Humans / Infant nutrition (including breastfeeding) / Infant, Newborn / Intensive care / Interventional radiology / Neonatal and paediatric intensive care / Neonatal care / Newborn babies / Paediatric Surgery / Paediatrics / Parenteral nutrition / Pediatrics / Premature babies / Ultrasonic imaging / Veins & arteries / Venous access