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Skin color change due to peripherally inserted central catheter leakage

Open AccessPublished:May 20, 2022DOI:https://doi.org/10.1016/j.pedneo.2022.04.005
      A girl weighing 564 g at 27 weeks of gestation was born by cesarean section due to fetal dysfunction. After birth, a peripherally inserted central catheter (PICC; Argyle™ PI Catheter Kit II 27G, Double Lumen, Covidien Japan, Tokyo, Japan) was indwelled from the right radial vein.
      A round white skin lesion with a 5-mm diameter was observed on the patient's right shoulder 30 h postnatally (Fig. 1A, arrow). No nodule was seen at the lesion site, and radiography revealed that it matched the PICC tip (Fig. 1B, arrowhead). At this time, a 14% glucose solution containing 1 g/kg/day of amino acids and 3 μg/kg/min of dopamine (concentration of 0.3 mg/ml) was administered via the PICC. Extravascular leakage of fluid was suspected and the PICC was reinserted. After the PICC removal from the right arm, the white-colored skin changes disappeared within a few minutes (Fig. 1C) without skin sequela.
      PICCs are widely used as a route for fluid infusion in neonates. Extravascular leakage associated with PICCs incidence is reported in approximately 1.4%.
      • Pet G.C.
      • Eickhoff J.C.
      • McNevin K.E.
      • Do J.
      • McAdams R.M.
      Risk factors for peripherally inserted central catheter complications in neonates.
      The presence of a PICC tip in the midclavicular region, such as in our patient, is one of the risk factors for extravascular leakage.
      • Jain A.
      • Deshpande P.
      • Shah P.
      Peripherally inserted central catheter tip position and risk of associated complications in neonates.
      Dopamine extravasation causes vasoconstriction and ischemia even at low doses;
      • Subhani M.
      • Sridhar S.
      • DeCristofaro J.D.
      Phentolamine use in a neonate for the prevention of dermal necrosis caused by dopamine: a case report.
      hence, we hypothesized that our patient may have developed a white ischemic change due to skin-capillary constriction from dopamine extravasation that constricts the peripheral blood vessels. We believe that prompt PICC leakage detection was an important factor in preventing skin necrosis in the patient. Therefore, frequently confirming that the tip of the PICC is appropriately in a central position in the body and the absence of skin abnormalities is important. With suspected extravascular leakage, PICC replacement should be promptly considered (see Fig. 1).
      Figure 1
      Figure 1Figure A. Round white skin lesion with a 5-mm diameter seen on the patient's right shoulder (arrow). Figure B. Chest radiography showing the tip of the PICC that matched the skin lesion (arrowhead). Figure C. White-colored skin changes disappeared a few minutes after the PICC removal.

      Funding

      This research did not receive any specific grant.

      Informed consent

      Written informed consent was obtained from the patient's parents for publication of this report and images.

      Declaration of competing interest

      All authors declare no conflicts of interest.

      References

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