Central venous catheter fracture leading to TPN extravasation and abdominal compartment syndrome diagnosed with bedside
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CASE REPORT
Central venous catheter fracture leading to TPN extravasation and abdominal compartment syndrome diagnosed with bedside contrast-enhanced ultrasound Anne Marie Cahill 1 & Fernando Escobar 1 & Michael R. Acord 1 Received: 17 June 2020 / Revised: 3 August 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Central venous lines may require contrast injection under fluoroscopy to evaluate for dysfunction such as occlusion, fibrin sheath development or catheter fracture. Rarely, some patients may be too ill to travel to the interventional radiology suite for this examination. We present a case utilizing contrast-enhanced ultrasound (CEUS) at the bedside to assess catheter integrity in a critically ill infant with a large intra-abdominal fluid collection. CEUS demonstrated extravasation into the collection, confirming catheter fracture and prompting immediate cessation of line use and recommendation for exchange. This case shows the utility of CEUS to evaluate central venous access devices in children who are unable to travel to interventional radiology for a standard contrast injection. Keywords Bedside . Catheter . Central venous access . Children . Contrast-enhanced ultrasound . Extravasation . Infant . Total parenteral nutrition
Introduction Complications of central venous access include infection, thrombosis, catheter occlusion or fracture, and extravasation [1]. For silicone tunneled central lines, fracture often occurs along the external portion of the catheter and is more common in children receiving total parenteral nutrition (TPN) and in those with dual lumen catheters [2]. When this occurs, either visible leakage or a visually apparent defect in the line is typically present, prompting repair or line replacement [3]. However, when there is concern for catheter fracture that is not clinically evident, such as within the subcutaneous tissues, or if there is catheter dysfunction of unknown etiology, contrast injection may be performed for further evaluation. This study is carried out using real-time fluoroscopy or digital Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00247-020-04825-8) contains supplementary material, which is available to authorized users. * Michael R. Acord [email protected] 1
Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
subtraction venography while iodinated contrast is simultaneously injected through the line. The exam, therefore, must be performed in an imaging suite rather than at the bedside. Here, we report a case utilizing contrast-enhanced ultrasound (CEUS) to evaluate catheter dysfunction at the bedside for a critically ill patient. To our knowledge, this application has not been reported in the literature.
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