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Pericardial effusions and cardiac tamponade associated with neonatal long lines - are they really a problem?

Presented at the Neonatal Society 2001 Summer Meeting (programme).

Beardsall K, White DK, Kelsall AWR.

Neonatal Intensive Care Unit, Rosie Hospital, Addenbrooke's Hospital, Cambridge. CB2 2QQ

Introduction: Percutaneous long lines (PLL) are now routinely used in neonatal intensive care units (NICU) and provide a safe and secure route of vascular access for the administration of parental nutrition. A number of different complications have been reported with pericardial effusion/cardiac tamponade being the most serious and potentially fatal. Parents have recently been made aware of this complication following media coverage. The neonatal literature contains only a few case reports. There are no studies that investigate the incidence of pericardial effusion/cardiac tamponade associated with the use of PLLs.

Methods: We have conducted a retrospective survey to determine the incidence of this problem over the last 5 years. A questionnaire was sent to the lead neonatal/paediatric clinician in all United Kingdom hospitals providing neonatal/special care.

Results: 243 questionnaires were sent and 173 returned (71%). 149 (86%) of the responding units routinely inserted PLLs. Of these, 103 (69%) inserted <50 PLLs and only 21 (14%) inserted > 100 PLLs per year. From the replies, we estimate that approximately 8,000 PLLs are inserted per annum. All units check the position of PLLs by x-ray but only 41 (27%) routinely use intravenous contrast. Eighty-six (58%) aimed to position the PLL in the vena cavae with the line tip outside the heart. Sixty-three (42%) were content with the PLL tip in the right atrium. Over the 5-year study period, 63 cases of pericardial effusion/cardiac tamponade were identified. Information was available in 62 cases. Thirty-four (55%) infants survived. The condition was suspected in 42 cases (68%) and confirmed by echocardiography in 28 (45%). Pericardial taps were attempted in 32 (52%). Of the 28 infants who died, diagnosis was made at post mortem in 20. Over the study period we estimate that 1.6 pericardial effusions/cardiac tamponades will occur for every 1,000 lines inserted, with a fatality rate of 0.7 per 1,000 PLLs inserted.

Conclusions: There is wide variation in the use of PLLs in neonates in the UK. The incidence of pericardial effusion/cardiac tamponade is very low. A significant proportion are diagnosed after death. Our figures almost certainly underestimate the incidence as it is a retrospective study. In addition, further cases may have been missed if post mortems were not performed. We aim to conduct a prospective study to determine the extent of the problem.

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