The authors report 2 neonatal deaths caused by cardiac tamponade related to peripherally inserted central catheters (PICCs). A total of 3 deaths were noted from 390 PICCs placed, giving an incidence of 0.76%. To determine the magnitude of neonatal death related to PICCs, directors of neonatal intensive care units were surveyed by means of a questionnaire. Myocardial perforation and pericardial effusion were reported by 29% and 43%, respectively. Deaths were attributed to PICCs by 24% of the respondants.

Comment. The finding of pericardial effusion and tamponade as a complication of PICCs is not new, but it appears that the frequency of these problems has been heretofore under-reported. These problems have also been reported as a complication of umbilical venous catheters when the catheter tip is placed inside the heart. These potentially lethal complications of central venous catheters are usually preventable by positioning the catheters with their tips in the superior or inferior vena cava, and not within the cardiac silhouette on chest radiograph. Also, reassess catheter tip position periodically, as catheter tip migration is common (especially with PICCs). Finally, remember to consider the possibility of pericardial effusion and tamponade in any patient with a central venous catheter who has a sudden decompensation. Prompt pericardio-centesis can be a life-saving procedure in this situation.