1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada.
2 Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada.
JPEN J Parenter Enteral Nutr. 2017 Sep;41(7):1234-1239. doi: 10.1177/0148607116644714. Epub 2016 Apr 15.
Although peripherally inserted central catheters (PICCs) provide vascular access in newborns who require parenteral nutrition and medications, they can be associated with complications that lead to significant morbidity and mortality.
To describe the characteristics of pleural effusion (PLE) associated with PICC use in a large level III neonatal intensive care unit.
DESIGN/METHODS: A retrospective review of PICC-related PLE in newborns was conducted over a 5-year period, from 2008-2012.
A total of 926 PICCs were inserted, accounting for 17,606 catheter days. PICC-related PLE was identified in 7 infants, with an incidence of 0.4 per 1000 catheter days. Infants who developed PLE had a median gestational age of 28 weeks (range, 24-38 weeks) and birth weight of 735 g (range, 500-2975 g). PICCs were inserted at a median age of 4 days (range, 3-11 days). The median time from catheter insertion to the development of PLE was 16 days (range, 7-75 days). In all cases, the catheter tips were centrally located at the time of insertion but migrated to the subclavian veins or tributaries at the time of the events.
PICC-related PLE can be associated with the migration of PICC tips to noncentral locations, despite optimal positioning of the tip at the time of insertion. Attention should be paid to migration of catheter tips on subsequent x-ray films. For PICCs inserted via upper limb or scalp, serial follow-up x-rays, beginning 1 week after insertion, may be helpful to detect migration of catheter tips and identify patients at risk.
虽然外周静脉置入中心导管（PICC）可为需要肠外营养和药物治疗的新生儿提供血管通路，但它也可能导致并发症，从而导致严重的发病率和死亡率。
描述在大型三级新生儿重症监护病房中与 PICC 使用相关的胸腔积液（PLE）的特征。
设计/方法：对 2008 年至 2012 年期间在新生儿重症监护病房中使用 PICC 进行回顾性研究。
共插入 926 根 PICC，导管留置时间为 17606 天。在 7 例新生儿中发现与 PICC 相关的 PLE，发生率为 0.4/1000 导管天。发生 PLE 的婴儿中位胎龄为 28 周（范围为 24-38 周），出生体重为 735 克（范围为 500-2975 克）。PICC 插入的中位年龄为 4 天（范围为 3-11 天）。从导管插入到 PLE 发展的中位时间为 16 天（范围为 7-75 天）。在所有情况下，导管尖端在插入时均位于中心位置，但在事件发生时迁移至锁骨下静脉或属支。
尽管在插入时尖端位置最佳，但 PICC 相关的 PLE 可能与 PICC 尖端向非中心位置的迁移有关。应注意后续 X 光片中导管尖端的迁移。对于通过上肢或头皮插入的 PICC，在插入后 1 周开始进行连续随访 X 光片可能有助于检测导管尖端的迁移并识别有风险的患者。
