Darling J C, Newell S J, Mohamdee O, Uzun O, Cullinane C J, Dear P R
Department of Paediatrics and Child Health, University of Leeds and United Leeds Teaching Hospitals Trust, Leeds, UK.
J Perinatol. 2001 Oct-Nov;21(7):461-4. doi: 10.1038/sj.jp.7210541.
Fatal cardiac tamponade is a well recognised complication of the use of central venous catheters in neonatal patients. There is controversy over optimum catheter tip position to balance catheter performance against risk of adverse events. We report a series of five cases of tamponade occurring in one neonatal unit over a 4-year period, related to catheter tip placement in the right atrium. Right atrial catheter angulation, curvature or looping (CA) was present in all five cases on plain radiograph. It was frequently seen in other patients over the same period. Review of the literature indicates that CA was present in 6 of the 11 previous cases where the presence or absence of CA can be determined. Where right atrial catheter tip placement is accepted, clinicians should be aware of this characteristic catheter configuration, which is a major risk factor for cardiac tamponade. We recommend that catheter tips should not be placed in the right atrium to avoid risk of tamponade.
致命性心脏压塞是新生儿使用中心静脉导管时一种广为人知的并发症。关于最佳导管尖端位置以平衡导管性能与不良事件风险存在争议。我们报告了在一个新生儿病房4年期间发生的一系列5例心脏压塞病例，均与导管尖端置于右心房有关。所有5例胸部X线平片均显示右心房导管有角度、弯曲或成袢（CA）。同期在其他患者中也经常见到这种情况。文献回顾表明，在之前11例可确定有无CA的病例中，有6例存在CA。在接受右心房导管尖端放置的情况下，临床医生应意识到这种特殊的导管形态，这是心脏压塞的主要危险因素。我们建议不应将导管尖端置于右心房以避免心脏压塞风险。
