Perforation complications of percutaneous central venous catheters in verylow birthweight infants

Objective: To prospectively survey perforation complications of consecutive ly inserted percutaneous central venous catheters (PCVC) in very low birthw eight (VLBW) infants over a 2 year period. Methodology and Results: Three serious perforation complications were encou ntered in a series of 100 consecutive PCVC. One infant (birthweight 685 g) developed pericardial effusion and fatal cardiac tamponade during the use o f a polyurethane PCVC. At autopsy, the pericardial sac contained 8 mt fluid with a glucose concentration of 109 mmol/L and the catheter tip was embedd ed in the right ventricular wall. The second infant (birthweight 1380 g) sh owed pleural effusion and transient immobility of the right diaphragmatic l eaf after perforation of a similar PCVC into the right pleural cavity. The third perforation, causing subcutaneous oedema, occurred in a 655 g infant who had a silastic PCVC. Conclusions: The data suggest a 3% incidence for PCVC-associated symptomati c perforation complications and a 1% incidence for fatal perforations, desp ite a policy of careful placement. The data also indicate that perforation complications occur regardless of the size or material of the PCVC. Proper visualization of the PCVC and vigilant attention to its location is require d to prevent these rare but potentially fatal complications.