Pediatric Radiology

, Volume 44, Issue 7, pp 810–815 | Cite as

Clinical-radiologic features and treatment of hepatic lesions caused by inadvertent infusion of parenteral nutrition in liver parenchyma due to malposition of umbilical vein catheters

  • Heidi E. Hagerott
  • Sakil Kulkarni
  • Ricardo Restrepo
  • Jesse Reeves-Garcia
Original Article

Abstract

Background

Umbilical venous catheterization is a common procedure performed in neonatal intensive care units. Hepatic collections due to inadvertent extravasation of parenteral nutrition into the liver have been described previously in literature.

Objective

To recognize the clinicoradiologic features and treatment options of hepatic collections due to inadvertent extravasation of parenteral nutrition fluids caused by malpositioning of umbilical venous catheter (UVC) in the portal venous system.

Materials and methods

This is a case series describing five neonates during a 6-year period at a single tertiary care referral center, with extravasation of parenteral nutrition into the liver parenchyma causing hepatic collections.

Results

All five neonates receiving parenteral nutrition presented with abdominal distension in the second week of life. Two out of five (40%) had anemia requiring blood transfusion and 3/5 (60%) had hemodynamic instability at presentation. Ultrasound of the liver confirmed the diagnosis in all the cases. Three of the five (60%) cases underwent US-guided aspiration of the collections, one case underwent conservative management and one case required emergent laparotomy due to abdominal compartment syndrome. US used in follow-up of these cases revealed decrease in size of the lesions and/or development of calcifications.

Conclusion

Early recognition of this complication, prompt diagnosis with US of liver and timely treatment can lead to better outcome in newborns with hepatic collections secondary to inadvertent parenteral nutrition infusion via malposition of UVC.

Keywords

Umbilical venous catheter Hepatic collections Parenteral nutrition Ultrasound- guided drainage Neonates 

References

  1. 1.
    Diamond LK (1947) Erythroblastosis faetalis or haemolytic disease of the newborn. Proc R Soc Med 40:456–550Google Scholar
  2. 2.
    Kabra NS, Kumar M, Shah SS (2005) Multiple versus single lumen catheters for newborn infants. Cochrane Database Syst Rev 20:CD004498Google Scholar
  3. 3.
    Sequin J, Fletcher MA, Landers S et al (1994) Umbilical venous catheterizations: audit by the Study Group for Complications of Perinatal Care. Am J Perinatol 11:67–70CrossRefGoogle Scholar
  4. 4.
    Greenberg M, Movahed H, Peterson B et al (1995) Placement of umbilical venous catheters with use of bedside real-time ultrasonography. J Pediatr 126:633–635PubMedCrossRefGoogle Scholar
  5. 5.
    Yigiter M, Arda IS, Hicsonmez A (2008) Hepatic laceration because of malpositioning of the umbilical vein catheter: case report and literature review. J Pediatr Surg 43:E39–E41PubMedCrossRefGoogle Scholar
  6. 6.
    Lam HS, Li AM, Chu WC et al (2005) Mal-positioned umbilical venous catheter causing liver abscess in a preterm infant. Biol Neonate 88:54–56PubMedCrossRefGoogle Scholar
  7. 7.
    Levkoff AH, Macpherson RI (1990) Intrahepatic encystment of umbilical vein catheter infusate. Pediatr Radiol 20:360–361PubMedCrossRefGoogle Scholar
  8. 8.
    Verheij GH, Te Pas AB, Witlox RS et al (2010) Poor accuracy of methods currently used to determine umbilical catheter insertion length. Int J Pediatr 873167. doi:10.1155/2010/873167
  9. 9.
    Lin-Dunham JE, Vade A, Capitano HN et al (2007) Characteristic sonographic findings of hepatic erosion of umbilical vein catheters. J Ultrasound Med 26:661–666Google Scholar
  10. 10.
    Coley B, Seguin J, Cordero L et al (1998) Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters. Pediatr Radiol 28:923–927PubMedCrossRefGoogle Scholar
  11. 11.
    Ades A, Sable C, Cummings S et al (2003) Echocardiographic evaluation of umbilical venous catheter placement. J Perinatol 23:24–28PubMedCrossRefGoogle Scholar
  12. 12.
    Oestreich AE (2010) Umbilical vein catheterization – appropriate and inappropriate placement. Pediatr Radiol 40:1941–1949PubMedCrossRefGoogle Scholar
  13. 13.
    Richter E, Lierse W (1991) Imaging atlas of the newborn. Urban & Schwarzenberg, BaltimoreGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Heidi E. Hagerott
    • 1
  • Sakil Kulkarni
    • 1
  • Ricardo Restrepo
    • 2
  • Jesse Reeves-Garcia
    • 3
  1. 1.Department of Medical EducationMiami Children’s HospitalMiamiUSA
  2. 2.Department of RadiologyMiami Children’s HospitalMiamiUSA
  3. 3.Department of GastroenterologyMiami Children’s HospitalMiamiUSA

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