PICC for Saturday, September 28th, 2024

History

Premie Neonate on high pressure ventilation. Vascular Access Team placed bedside PICC. Patient decompensated as the PICC dressing was being applied.

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Question

What is the cause of the acute decompensation?

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Correct answer

Something not related to the PICC

Discussion

There is a large left tension pneumothorax almost certainly NOT related to PICC placement.

The PICC loop in the inferior right jugular vein is common and will probably resolve spontaneously. It will not cause any PICC use issues, but needs to be monitored by chest radiographs to ensure that the PICC tip does not descend too far into the right atrium, risking pericardial tamponade.

The ETT is in good position.

There is a previously placed left pigtail chest tube, indicating that the patient had a previous pneumothorax What probably happened is that the left pigtail chest tube became obstructed and the high pressure ventilation caused a return of the left pneumothorax.

In this case, the diagnosis was delayed but once established, partial withdrawal of the chest tube at the bedside resolved the issue
Nursing staff are not expected to interpret radiographs independently but should be aware of the possibility of incidental events occurring, especially in sick neonates and ask for immediate radiology interpretation if available.

Differential diagnosis

None