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Vijay Tukaram Mali

 

Vijay Tukaram Mali

NICE Advanced Neonatal Care Center And Children’s Clinic,
India

Abstract Title: Massive Pleural Effusion Secondary to PICC Line Migration and Hyperosmolar Fluid Extravagation in a Preterm Neonate: A Case Report

Biography:

Dr.Vijay Mali has completed MD in pediatrics then he did Neonatology Intensive Care Fellowship at Manipal University and John Radcliff Hospital United Kingdom. He is the founder and director of NICE Advanced Neonatal Care Centre and Children’s Clinic in Kolhapur, Maharashtra, INDIA. Published more than 10 international publications and 4 Indian Patents for Indian Government and one Australian Patent product.

Research Interest:

Massive Pleural Effusion Secondary to PICC Line Migration and Hyperosmolar Fluid Extravagation in a Preterm Neonate: A Case Report

Peripherally inserted central catheters (PICC) are widely used in neonatal intensive care units for prolonged vascular access. Although considered safe, PICC line malposition  and migration can lead to life-threatening complications such as pleural effusion and hydrothorax, particularly when Hyperosmolar fluids are infused.

We report a case of a 28-week preterm male neonate (birth weight 960 g) who developed massive bilateral pleural effusion on day 23 of life. The baby was referred for worsening respiratory distress and ventilator requirement in the background of Stage III necrotizing enter colitis. Chest radiograph revealed large right-sided (34 mm) and moderate left-sided (24 mm) effusions. Pleural tapping yielded clear fluid with glucose of 450 mg/dL, significantly higher than the simultaneous blood glucose (54 mg/dL), suggesting extravasations of parenteral nutrition. The PICC line tip, initially placed in the great saphenous vein, had migrated 4 cm beyond the insertion length and was located in a low-flow venous system. Immediate PICC line removal and intercostal drainage (ICD) resulted in marked clinical improvement. The ICD was removed after3 days, and the baby was successfully weaned from mechanical ventilation.

This case underscores the importance of frequent imaging for catheter tip confirmation, particularly following neonatal transport. A high pleural fluid-to-blood glucose ratio should alert clinicians to extravasation. Early recognition and timely intervention are critical in prevention Morbidity and mortality