Garg M, Chang C C, Merritt R J
Division of Neonatology/Pediatric Pulmonology, Childrens Hospital Los Angeles, CA 90027.
J Perinatol. 1989 Dec;9(4):456-7.
The use of central venous catheters in very low birthweight infants to provide adequate calories for growth is an integral part of the care of the high-risk neonate. The use of surgically placed Broviac catheters has been associated with infectious and mechanical complications. Recently, there has been increasing use of silastic central venous catheters inserted through a peripheral vein and advanced to the right atrium. These catheters have a reported low rate of complications. However, we report a case of a very low birthweight infant in whom a peripherally inserted silastic catheter perforated the wall of the right atrial appendage and led to fatal pericardial tamponade. This is a very rare but nearly always fatal complication. It is potentially avoidable by careful placement of the tip of the central venous catheter, so that it is not impinging on a wall of the heart. Serial venograms may be useful to reconfirm the position of the catheter.
在极低出生体重儿中使用中心静脉导管以提供足够热量促进生长，是高危新生儿护理的一个重要组成部分。使用外科置入的Broviac导管会出现感染和机械性并发症。近来，经外周静脉插入并推进至右心房的硅橡胶中心静脉导管的使用日益增多。据报道，这些导管的并发症发生率较低。然而，我们报告了一例极低出生体重儿，其经外周插入的硅橡胶导管穿透了右心耳壁，导致致命的心包填塞。这是一种非常罕见但几乎总是致命的并发症。通过仔细放置中心静脉导管尖端，使其不压迫心脏壁，有可能避免这种情况。连续静脉造影可能有助于再次确认导管位置。
