Fainting Starting Parenteral Nutrition Federica Pederiva, MD, PhD,* Egidio Barbi, MD,† Floriana Zennaro, MD,‡ and Elena Neri, MD, PhD† Abstract: Complications such as mechanical accidents, infections, and thrombosis are commonly described in the presence of a central venous catheter. We present a case of a boy who had fainting episodes due to dislocation of a central venous catheter. Key Words: central venous catheter complications, central line, carotid sinus (Pediatr Emer Care 2015;31: 648–648)
echanical accidents, infections, and thrombosis are the most common complications related to the presence of a central venous catheter (CVC). We present a case of a boy who had fainting episodes due to dislocation of a CVC.
CASE A 13-year-old boy with total colonic aganglionosis and double-barrel stoma was admitted for a 2-week history of syncope at the beginning of parenteral nutrition infusion. He had a 6.6-Fr single-lumen silicone-cuffed and -tunneled CVC inserted 9 years before in the right internal jugular vein. The X-ray confirmed that the catheter tip had migrated from the superior vena cava to the internal jugular vein (Fig. 1). The catheter was replaced with resolution of the fainting episodes, which were related to the carotid sinus overstimulation by the pressure at the start of infusion.
DISCUSSION Dislocation of the CVC may originate from accidental self-removal by the patient, especially by younger children, nonoptimal size of the Dacron cuff or its incomplete cicatrization and adhesion to the subcutaneous tunnel tissue. Although this complication has been described in 8.9% of adults in whom a tunneled CVC was inserted,1 the percentage reaches 30% in children with similar devices.2 The ongoing growth of children becoming “young adults” has to be kept in mind by pediatricians as a possible cause of dislocation of the catheter tip from the cavoatrial junction. To the best of our knowledge, this is the first report of a dislocated CVC related to fainting episodes secondary to carotid
FIGURE 1. X-ray showing the migration of the CVC tip from the cavoatrial junction to the right internal jugular vein.
sinus stimulation. Even if it is very rare, this possibility should be considered in the differential diagnosis of critical episodes in patients with a CVC. REFERENCES 1. Cotogni P, Pittiruti M, Barbero C, et al. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51,000 catheter days. JPEN J Parenter Enteral Nutr. 2013;37:375–383. 2. Pinon M, Bezzio S, Tovo PA, et al. A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr. 2009;168:1505–1512.
From the Departments of *Pediatric Surgery, †Emergency, and ‡Radiology, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy. Disclosure: The authors declare no conflict of interest. Reprints: Federica Pederiva, MD, PhD, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy (e‐mail: [email protected]
). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161
Pediatric Emergency Care • Volume 31, Number 9, September 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.