经下肢静脉置入中心静脉导管并发新生儿胸腔积液1例

A case of neonatal pleural effusion due to central venous catheter inserted through lower limb veins

经外周置入中心静脉导管(PICC)是危重症新生儿,特别是极/超低出生体重儿常用的静脉通路。胸腔积液是PICC相关并发症之一,严重者可危及生命。经上肢静脉置入PICC并发胸腔积液时有报道,但经下肢静脉置管并发胸腔积液的案例较罕见。本文介绍1例32+6周的新生儿,出生第3天经下肢大隐静脉置入PICC输注静脉营养液(TPN),出生第9天出现呼吸急促、心率增快等症状,胸片及B超结果显示胸腔积液,拔除该导管2 d后,胸腔积液消失。通过患儿胸片结果并结合相关文献,考虑本案例发生的原因是PICC导管误入奇静脉引起的胸腔积液。

Peripherally inserted central catheter(PICC)is a common vein access in critically ill newborns,especially in very low birth weight infants or extremely low birth weight infants.Pleural effusion is one of the complications related to PICC,which can be life-threatening in severe cases.It has been reported from time to time that PICC was placed through the upper extremity veins and complicated with pleural effusion,but the cases of pleural effusion complicated by the catheterization through the lower extremity veins is rare.This paper presented a case of newborn with 32+6 weeks,who was infused with intravenous nutrient solution(TPN)by PICC through the great saphenous vein of lower extremity on the 3rd day after birth.On the 9th day after birth,the baby developed symptoms such as shortness of breath and rapid heart rate.Chest radiography and B-ultrasound showed pleural effusion,which disappeared two days after the catheter was removed.Based on the results of chest radiographs of the child and related literature,it was considered that the cause of this case was pleural effusion caused by the misinsertion of PICC catheter into the azygian vein.