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Journal of Radiology Case Reports

Lipid Infusion Through Malpositioned Central Venous Catheter: Head Ultrasound Features

Case Report

Morgan Roth Goldberg 1*, Dorothy Gilbertson-Dahdal1

Radiology Case. 2009 Nov; 3(11):13-19 :: DOI: 10.3941/jrcr.v3i11.320

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1. Department of Radiology, University of Arizona, Tucson, AZ, USA

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  ABSTRACT
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Properly placed central venous catheters have been effective in establishing prolonged access for total parenteral nutrition infusion in ill neonates. However, malposition of the catheter may lead to lethal complications. Malposition and infusion into the epidural venous plexus is most commonly diagnosed on the basis of radiographs and has been confirmed by lumbar puncture. Several studies describe catheter malposition and associated complications. None, however, demonstrate head ultrasound features. We present sonographic findings in a patient who received hyperalimentation for 15 days through a malpositioned lower extremity peripherally inserted central venous catheter.



  CASE REPORT
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The patient was a 1,430 gram male neonate born at 30 4/7 weeks via vaginal delivery to an 18-year-old gravida 1, para 0 mother. The mother received 1 dose of steroids and 2 doses of antibiotics for prophylaxis prior to delivery. Non reassuring fetal heart tones led to induction of labor and artificial rupture of membranes. APGAR scores were 3 and 7, at 1 and 5 minutes respectively. The patient continued to experience respiratory distress, was intubated immediately upon arrival to the neonatal intensive care unit, and received 1 dose of surfactant. The first day after delivery, a peripherally inserted central venous catheter (PICC) was inserted into the patient`s left saphenous vein. An AP abdominal radiograph was obtained, the radiologist`s interpretation was that the line terminated at the L3 level, and total parenteral nutrition was initiated. The patient developed a new cardiac murmur on day 4 and subsequent echocardiogram revealed a PDA. The patient was started on an intravenous NSAID in attempt to close the PDA, which was discontinued on day 5 after head ultrasound revealed a grade 3 left germinal matrix hemorrhage and a grade 1 right germinal matrix hemorrhage (Fig. 1 Preview this figure

Figure 1: Ultrasound
5 day old male with grade 3 left germinal matrix hemorrhage. Grayscale ultrasound images through the anterior fontanelle in the parasagittal plane demonstrate echogenic material in the left caudothalamic groove and in the atria of the left ventricle. There is hydrocephalus.
, Fig. 2 Preview this figure
Figure 2: Ultrasound
5 day old male with grade 1 right germinal matrix hemorrhage. Grayscale ultrasound image through the anterior fontanelle in the parasagittal plane demonstrates echogenic material in the right caudothalamic groove.
). The NSAID was subsequently re-initiated after the germinal matrix hemorrhage remained stable for 48 hours. On day 8, the patient began to experience changes on physical examination and was described as limp and minimally responsive. It was hypothesized that clinical deterioration was due to the large PDA, for which he underwent ligation on day 10. On day 12, follow-up head ultrasound revealed echogenic material within the subarachnoid space and venous sinuses (Fig. 3 Preview this figure
Figure 3: Ultrasound
12 day old male with malpositioned central venous catheter. Grayscale ultrasound image of the posterior fossa through the mastoid fontanelle in the axial plane demonstrates echogenic material within subarachnoid/subdural space surrounding the right cerebellum.
, Fig. 4 Preview this figure
Figure 4: Ultrasound
12 day old male with malpositioned central venous catheter. Grayscale ultrasound image of the posterior fossa through the mastoid fontanelle in the axial plane demonstrates echogenic material within subarachnoid/subdural space surrounding the left cerebellum.
). A sepsis evaluation including lumbar puncture was conducted on day 15. The cerebrospinal fluid appeared milky white, and laboratories indicated 9292mg/dl glucose, 3375 mg/dL triglycerides, 112 mg/dL proteins, and no organisms. These findings, consistent with parenteral nutrition infusion, prompted review of the initial frontal radiograph; the catheter projected towards the midline and there was an abnormal kink. This led to suspicion that the catheter was not in the appropriate vessel (Fig. 5 Preview this figure
Figure 5: Conventional Radiography
1 day old male with malpositioned central venous catheter. Frontal abdominal radiograph demonstrates abnormal kink and that the catheter tip terminates left of the midline.
). A subsequent cross table lateral radiograph confirmed that the catheter deviated posteriorly and into the ascending lumbar vein (Fig. 6 Preview this figure
Figure 6: Conventional Radiography
15 day old male with malpositioned central venous catheter. Cross table lateral radiograph demonstrating posterior projection of the catheter into the ascending lumbar vein (magnification in lower half of figure).
). Hyperalimentation was terminated immediately and the catheter was removed. An MRI of the brain and spine conducted 4 days later demonstrated dependently layering proteinaceous material and or hemorrhage in the lateral ventricles (Fig. 7 Preview this figure
Figure 7: Magnetic Resonance Imaging
20 day old male with malpositioned central venous catheter. Axial T2W FLAIR MRI image (TR=8002, TE=128.66, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the lateral ventricles demonstrates material with abnormally decreased T2 signal layering in the dependent portion of the right lateral ventricle.
, Fig. 8 Preview this figure
Figure 8: Magnetic Resonance Imaging
. 20 day old male with malpositioned central venous catheter. Axial T1W MRI image (TR=416.66, TE=16, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the lateral ventricles demonstrates increased T1 signal material layering posteriorly in the right lateral ventricle.
), subarachnoid/subdural space, (Fig. 9 Preview this figure
Figure 9: Magnetic Resonance Imaging
20 day old male with malpositioned central venous catheter. Axial T2W FLAIR MRI image (TR=8002, TE= 128.66, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the cerebellum demonstrates hyperintense signal within the subarachnoid/subdural space surrounding the cerebellum.
, Fig. 10 Preview this figure
Figure 10: Magnetic Resonance Imaging
20 day old male with malpositioned central venous catheter. Axial T1W MRI image (TR=416.66, TE=16, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the cerebellum demonstrates hyperintense signal within the subarachnoid/subdural space surrounding the cerebellum.
) and an extensive fluid containing epidural collection consistent with cord compression (Fig. 11 Preview this figure
Figure 11: Magnetic Resonance Imaging
20 day old male with malpositioned central venous catheter. Sagittal post contrast T1W MRI image of the spine (TR=400, TE=11, 1.5T, SL=3mm) with fat saturation after injecting 0.35mL of magnevist (gadopentetate dimeglumine) demonstrates a prominent collection of low signal in the posterior epidural space along the majority of the spine compatible with lipid and fluid. (long arrow) The thecal sac is effaced in the cervical to upper thoracic spine and there is mass effect on the spinal cord. Note is made of an enhancing epidural vein. (short arrow)
, Fig. 12 Preview this figure
Figure 12: Magnetic Resonance Imaging
20 day old male with malpositioned central venous catheter. Sagittal post contrast T2W MRI image of the spine (TR=2616.66, TE=96.45, 1.5T, SL=3mm) after injecting 0.35mL of magnevist (gadopentetate dimeglumine) demonstrates a prominent collection of high T2 weighted signal in the posterior epidural space along the majority of the spine compatible with lipid and fluid. The thecal sac is effaced in the cervical to upper thoracic spine and there is mass effect on the spinal cord.
). The patient subsequently underwent several exploratory spinal surgeries in an attempt to relieve pressure, but the patient did not clinically improve. The attending neurosurgeon identified fibrosis and scarring around the spinal cord likely due to chemical irritation and necrosis, rather than compression of the spinal cord. Unfortunately, the patient passed 36 days after the malpositioned catheter was identified and removed.

  DISCUSSION
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Properly placed PICC lines into the left saphenous vein ascend via the left iliac vein, project to the right of midline at the L4-L5 level, and ascend in the inferior vena cava. However, it is possible for the catheter to deviate posteriorly and enter the epidural venous plexus via the ascending lumbar vein (1-3). This case describes a patient whose central catheter entered the epidural venous plexus through an ascending lumbar vein and perforated it, with subsequent infusion into the CSF.

The absence of blood with line aspiration, respiratory distress, neurologic deficits, elevated cerebrospinal protein, glucose, and lipid in a patient receiving central venous hyperalimentation may indicate line malposition (2,3). Likewise, subtle lateral deviation of the catheter at the level of L4 -L5 and catheter path directly over the vertebral column, rather than to the right of midline on frontal abdominal radiographs, suggests malposition (2,4). Furthermore, pulsatile flow of bright red blood suggests arterial placement.

Complications associated with catheter malposition into the epidural venous plexus include venous stasis and thrombosis, vasculitis, increased pressure in the spinal canal, spinal cord injury, and perforation into the subarachnoid space (2). The literature describes at least 12 patients with central venous catheter malposition (2,4-8). 5 of these patients were found to have milky cerebrospinal fluid, 2 developed neurologic sequele including seizure, quadriplegia, urinary retention, and 1 suffered cardiac arrest. Full recovery was observed in 7 of these patients when the catheter was removed immediately and 2 suffered lethal complications related to malposition (2). There have been at least 10 cases of neurologic complications reported in neonates caused by malposition of lower extremity central venous catheters into the ascending lumbar vein. The interval between placement of the catheter and appearance of symptoms ranged from 1 to 11 days. Our patient developed neurologic changes on day 8. In all cases, initial placement of the catheter was considered satisfactory based on standard anteroposterior radiographs (2,3,4,9-16).

When frontal radiographs are difficult to interpret, cross table lateral radiographs more clearly demonstrate the posterior course of malpositioned catheters into the ascending lumbar veins. The subtle posterior deviation of the catheter was not recognized in our patient on the initial radiograph. Head ultrasound revealed hyperechoic material in the subarachnoid space. Initially, this material was felt to represent blood. Sonographic features of hyperalimentation infusion through malpositioned catheters have not been described in the literature. Consequently, clinical correlation, cerebrospinal laboratories, and review of the initial AP and cross table lateral radiographs supports that our patient`s ultrasound findings are a result of the catheters malposition.

  TEACHING POINT
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Cross table lateral radiographs are recommended in neonates to confirm initial lower extremity PICC line placement. If head ultrasound reveals hyperechoic material in the subarachnoid space, review of the patients line position may be warranted.








  FIGURES
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Display figure 1 in original size

Figure 1: 5 day old male with grade 3 left germinal matrix hemorrhage. Grayscale ultrasound images through the anterior fontanelle in the parasagittal plane demonstrate echogenic material in the left caudothalamic groove and in the atria of the left ventricle. There is hydrocephalus.

Figure 1: Ultrasound (Open in original size)
5 day old male with grade 3 left germinal matrix hemorrhage. Grayscale ultrasound images through the anterior fontanelle in the parasagittal plane demonstrate echogenic material in the left caudothalamic groove and in the atria of the left ventricle. There is hydrocephalus.

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Display figure 2 in original size
Figure 2: 5 day old male with grade 1 right germinal matrix hemorrhage. Grayscale ultrasound image through the anterior fontanelle in the parasagittal plane demonstrates echogenic material in the right caudothalamic groove.

Figure 2: Ultrasound (Open in original size)
5 day old male with grade 1 right germinal matrix hemorrhage. Grayscale ultrasound image through the anterior fontanelle in the parasagittal plane demonstrates echogenic material in the right caudothalamic groove.

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Display figure 3 in original size
Figure 3: 12 day old male with malpositioned central venous catheter. Grayscale ultrasound image of the posterior fossa through the mastoid fontanelle in the axial plane demonstrates echogenic material within subarachnoid/subdural space surrounding the right cerebellum.

Figure 3: Ultrasound (Open in original size)
12 day old male with malpositioned central venous catheter. Grayscale ultrasound image of the posterior fossa through the mastoid fontanelle in the axial plane demonstrates echogenic material within subarachnoid/subdural space surrounding the right cerebellum.

Back Back


Display figure 4 in original size
Figure 4: 12 day old male with malpositioned central venous catheter. Grayscale ultrasound image of the posterior fossa through the mastoid fontanelle in the axial plane demonstrates echogenic material within subarachnoid/subdural space surrounding the left cerebellum.

Figure 4: Ultrasound (Open in original size)
12 day old male with malpositioned central venous catheter. Grayscale ultrasound image of the posterior fossa through the mastoid fontanelle in the axial plane demonstrates echogenic material within subarachnoid/subdural space surrounding the left cerebellum.

Back Back


Display figure 5 in original size
Figure 5: 1 day old male with malpositioned central venous catheter. Frontal abdominal radiograph demonstrates abnormal kink and that the catheter tip terminates left of the midline.

Figure 5: Conventional Radiography (Open in original size)
1 day old male with malpositioned central venous catheter. Frontal abdominal radiograph demonstrates abnormal kink and that the catheter tip terminates left of the midline.

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Display figure 6 in original size
Figure 6: 15 day old male with malpositioned central venous catheter. Cross table lateral radiograph demonstrating posterior projection of the catheter into the ascending lumbar vein (magnification in lower half of figure).

Figure 6: Conventional Radiography (Open in original size)
15 day old male with malpositioned central venous catheter. Cross table lateral radiograph demonstrating posterior projection of the catheter into the ascending lumbar vein (magnification in lower half of figure).

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Display figure 7 in original size
Figure 7: 20 day old male with malpositioned central venous catheter. Axial T2W FLAIR MRI image (TR=8002, TE=128.66, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the lateral ventricles demonstrates material with abnormally decreased T2 signal layering in the dependent portion of the right lateral ventricle.

Figure 7: Magnetic Resonance Imaging (Open in original size)
20 day old male with malpositioned central venous catheter. Axial T2W FLAIR MRI image (TR=8002, TE=128.66, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the lateral ventricles demonstrates material with abnormally decreased T2 signal layering in the dependent portion of the right lateral ventricle.

Back Back


Display figure 8 in original size
Figure 8: . 20 day old male with malpositioned central venous catheter. Axial T1W MRI image (TR=416.66, TE=16, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the lateral ventricles demonstrates increased T1 signal material layering posteriorly in the right lateral ventricle.

Figure 8: Magnetic Resonance Imaging (Open in original size)
. 20 day old male with malpositioned central venous catheter. Axial T1W MRI image (TR=416.66, TE=16, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the lateral ventricles demonstrates increased T1 signal material layering posteriorly in the right lateral ventricle.

Back Back


Display figure 9 in original size
Figure 9: 20 day old male with malpositioned central venous catheter. Axial T2W FLAIR MRI image (TR=8002, TE= 128.66, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the cerebellum demonstrates hyperintense signal within the subarachnoid/subdural space surrounding the cerebellum.

Figure 9: Magnetic Resonance Imaging (Open in original size)
20 day old male with malpositioned central venous catheter. Axial T2W FLAIR MRI image (TR=8002, TE= 128.66, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the cerebellum demonstrates hyperintense signal within the subarachnoid/subdural space surrounding the cerebellum.

Back Back


Display figure 10 in original size
Figure 10: 20 day old male with malpositioned central venous catheter. Axial T1W MRI image (TR=416.66, TE=16, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the cerebellum demonstrates hyperintense signal within the subarachnoid/subdural space surrounding the cerebellum.

Figure 10: Magnetic Resonance Imaging (Open in original size)
20 day old male with malpositioned central venous catheter. Axial T1W MRI image (TR=416.66, TE=16, 1.5T, SL=4mm) without intravenous contrast through the brain at the level of the cerebellum demonstrates hyperintense signal within the subarachnoid/subdural space surrounding the cerebellum.

Back Back


Display figure 11 in original size
Figure 11: 20 day old male with malpositioned central venous catheter. Sagittal post contrast T1W MRI image of the spine (TR=400, TE=11, 1.5T, SL=3mm) with fat saturation after injecting 0.35mL of magnevist (gadopentetate dimeglumine) demonstrates a prominent collection of low signal in the posterior epidural space along the majority of the spine compatible with lipid and fluid. (long arrow) The thecal sac is effaced in the cervical to upper thoracic spine and there is mass effect on the spinal cord. Note is made of an enhancing epidural vein. (short arrow)

Figure 11: Magnetic Resonance Imaging (Open in original size)
20 day old male with malpositioned central venous catheter. Sagittal post contrast T1W MRI image of the spine (TR=400, TE=11, 1.5T, SL=3mm) with fat saturation after injecting 0.35mL of magnevist (gadopentetate dimeglumine) demonstrates a prominent collection of low signal in the posterior epidural space along the majority of the spine compatible with lipid and fluid. (long arrow) The thecal sac is effaced in the cervical to upper thoracic spine and there is mass effect on the spinal cord. Note is made of an enhancing epidural vein. (short arrow)

Back Back


Display figure 12 in original size
Figure 12: 20 day old male with malpositioned central venous catheter. Sagittal post contrast T2W MRI image of the spine (TR=2616.66, TE=96.45, 1.5T, SL=3mm) after injecting 0.35mL of magnevist (gadopentetate dimeglumine) demonstrates a prominent collection of high T2 weighted signal in the posterior epidural space along the majority of the spine compatible with lipid and fluid. The thecal sac is effaced in the cervical to upper thoracic spine and there is mass effect on the spinal cord.

Figure 12: Magnetic Resonance Imaging (Open in original size)
20 day old male with malpositioned central venous catheter. Sagittal post contrast T2W MRI image of the spine (TR=2616.66, TE=96.45, 1.5T, SL=3mm) after injecting 0.35mL of magnevist (gadopentetate dimeglumine) demonstrates a prominent collection of high T2 weighted signal in the posterior epidural space along the majority of the spine compatible with lipid and fluid. The thecal sac is effaced in the cervical to upper thoracic spine and there is mass effect on the spinal cord.

Back Back


  REFERENCES
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1. Lussky R, Trower N, Fisher D. Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate. Am J Perinatol 1997 Feb;14(2):63-7 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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2. Chen-Chun C, Tsao P, Yau K. Paraplegia: complication of percutaneous central venous line malposition. Pediatric Neurol 2001 Jan;24(1):65-68 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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3. Ramasethu J. Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol 2008 Mar;35(1):199-222 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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4. Lavandosky G, Gomez R, Montes J. Potentially lethal misplacement of femoral central venous catheters. Pediatric Critical Care Medicine 1996 May;24(5)893-6 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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5. Odaibo F, Fajardo C, Cronin C. Recovery of intralipid from lumbar puncture after migration of saphenous vein catheter. Arch Dis Child 1992 Oct;67(10):1201-3 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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6. Mah M, Fain J, Hall S. Radiological case of the month. intravenous hyperalimentation fluid obtained with lumbar puncture: an unusual complication of a central venous catheter Am J Dis Child Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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7. White L, Montes J, Chaves C. Radiological case of the month. subarachnoid malposition of femoral vein catheter Am J Dis Child Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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8. Kelly M, Finer N, Dunbar L. Fatal neurologic complication of parenteral feeding through a central vein catheter. Am J Dis Child 1984 Apr;138(4)352-3 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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9. Knobel R, Meetze W, Cummings J. Case report: total parenteral nutrition extravasation associated with spinal cord compression and necrosis. J Perinatol 2001 Jan-Feb;21(1)68-71 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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10. Rajan V, Waffarn F. Focal neurological manifestations following aberrant central venous catheter placement. J Perinatol 1999 Sep;19(6): 447-449 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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11. Bass W, Lewis D. Neonatal segmental myoclonus associated with hyperglycorrachia. Pediatr Neurol 1995 Jul;13(1):77-79 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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12. Mitsufuji N, Matsuo K, Kakita S. Extravascular collection of fluid around the vertebra resulting from malpositioning of a peripherally inserted central venous catheter in extremely low birth weight infants. J Perinat Med 2002 30(4):341-344 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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13. Filan P, Salek- Haddadi Y, Nolan I. An under-recognized malposition of neonatal long lines. Eur J Pediatr 2005 Aug;164(8): 469-471 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

14. Zenker M, Rupprecht T, Hofbeck M. Paravertebral and intraspinal malposition of transfemoral central venous catheters in newborn. J Pediatr 2000 Jun;136(6):837-840 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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15. Clarke P, Wadhawan R, Smyth J. Parenteral nutrition solution retrieved by lumbar puncture following left saphenous vein catheterization. J Paediatr Child Health 39 Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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16. Bergman K, Doedens R, VDAkker D. Displacement and extravascular position of a saphenous vein catheter: a serious complication. Eur J Pediatr 1999 Oct;158(10): 868-869. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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  ABBREVIATIONS
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Abbreviations
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PICC = peripherally inserted central catheter
PDA = patent ductus arteriosis
NSAID = non-steroidal anti-inflammatory
MRI = magnetic resonance imaging








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