Diagnosis and Management of Spinal Epidural Space Extravasation Complicating Percutaneous Central Venous Line Placement in a Premature Infant: Case Report and Review of Literature
A. Vidwans, D. Neumann, N. Hussain, T. Rosenkrantz and M. Sanders, Univeristy of Connecticut School of Medicine, Farmington.
ABSTRACT-Percutaneous central venous lines are commonly used to establish long-term venous access in the care of premature infants. Misplacement of these catheters can occur and may lead to significant morbidity and mortality. Here we report a very-low-birth-weight premature infant whose percutaneous central venous line was inadvertently placed into the spinal epidural space. The anatomical basis of this complication as well as a comprehensive review of literature are provided.
Introduction
INFANTS in the newborn intensive care unit (NICU), who require long-term parenteral therapy often need a central venous line placement subsequent to discontinuation of the umbilical arterial catheter (UAC) or umbilical venous catheter (UVC).
Central venous access may be obtained by surgical placement of a Broviac® catheter or a Silastic® percutaneous central venous line (PCVL). Although PCVLs are an effective means of long-term intravenous access, it has been recognized that PCVL-related complications such as infection, leakage, occlusion, and dislodgment may result in significant morbidity or mortality.1-3
One unusual complication from a PCVL placed via the saphenous vein or the femoral vein is the inadvertent cannulation of the ascending lumbar vein leading to the epidural venous plexus.4-7
Retrograde flow of parenteral fluid into the epidural venous plexus from a venous thrombosis induced by a PCVL in the common iliac vein has also been reported.8
Although these reports have highlighted the need for awareness of this complication, little is known about its clinical management.
Here we report a case documenting the diagnosis and management of spinal epidural effusion of parenteral fluid.
Connecticut Medicine, Feb 2000, Vol 64, No. 2
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