Delayed umbilical venous catheter migration causing acute respiratory deterioration in a preterm neonate: a case report

Umbilical venous catheters are often used in neonatal intensive care units and are usually considered relatively safe. Pleural effusion secondary to UVC extravasation is an uncommon but potentially life-threatening complication. A 33-week, 1310 g preterm neonate initially improved following respiratory support with nasal CPAP after birth. On day 6 of life, he developed sudden respiratory deterioration requiring invasive ventilation. Chest radiograph and bedside lung ultrasound demonstrated a massive right pleural effusion. Pleural drainage yielded clear, straw coloured, transudative fluid with markedly elevated glucose concentration, suggesting extravasation of infused intravenous fluid. Although the UVC appeared appropriately positioned on the initial radiograph, subsequent imaging demonstrated catheter tip migration with distal kink below the diaphragm. Removal of the catheter resulted in rapid resolution of pleural effusion and complete clinical recovery, without recurrence. Delayed migration of a previously well-placed UVC should be considered in the differential diagnosis of sudden unexplained respiratory deterioration in neonates. Pleural fluid with significantly elevated glucose, combined with bedside point-of-care ultrasonography, would help in the rapid diagnosis of catheter-related extravasation. Serial assessment of catheter position throughout the entire catheterization period, may play a crucial role and facilitate early detection of potential complications.