(1316) Bilateral Pleural Effusions Following Right Internal Jugular Catheterization

Introduction: Central venous catheterization (CVC) is a common procedure performed in the intensive care unit (ICU). Ipsilateral pleural effusions are a known complication and suggest catheter malposition and/or migration. Bilateral pleural effusions are rare and suggest the pleural cavities communicate. We present a case of bilateral pleural effusions after right internal jugular (RIJ) catheterization.

Description: A 13-day old male born full term was admitted to the pediatric ICU with neonatal sepsis requiring mechanical ventilation, fluid resuscitation, and vasoactive support. A 4 French 8cm double lumen RIJ catheter was placed with ultrasound guidance under sterile technique. Placement was confirmed with free aspiration of blood from both lumens and chest x-ray (CXR) showing the catheter tip in the proximal superior vena cava. Fifteen hours later he required increased ventilatory support, and CXR showed a moderate-sized right pleural effusion with the RIJ catheter overlying the superior mediastinum. Shortly after the patient had a cardiac arrest during which a right sided pigtail catheter was placed with 50mL serosanguinous fluid drained. Return of spontaneous circulation was achieved after 13 minutes. CXR 3 hours later showed the RIJ catheter tip projecting over the superior mediastinum, uncertain location, and a large left pleural effusion. A left pigtail catheter was placed with 80mL serosanguinous fluid drained. Pleural fluid from the right and left pigtail showed glucose 1336mg/dL and 577mg/dL respectively, and serum glucose 420mg/dL. This was felt to be indicative of the dextrose 5% intravenous fluids and vasoactive drips in dextrose 5% water being administered through the RIJ catheter. The bilateral pleural effusions were felt to be a complication of the RIJ catheter tip migrating into the mediastinum, and this line was subsequently removed. The patient was successfully extubated 3 days later with chest tubes removed on day 6. He was discharged home after completion of antibiotic course.

Discussion: Optimal positioning of a central venous catheter is imperative to avoid complications. This case reports a rare complication of bilateral pleural effusions following CVC that remains to be anatomically explained.