Issn Print: 0090-3493
Publication Date: 2006/12/01
NOVEL DIAGNOSIS OF A TOTAL PARENTERAL NUTRITION HYDROTHORAX USING A NEW BEDSIDE VASCULAR ACCESS ULTRASOUND DEVICE.: 604
Nicholas B Slamon; Scott Penfil
Excerpt
We report a case of total parenteral nutrition hydrothorax successfully diagnosed with the aid of the PunctSURE ultrasonic vascular imaging system (Inceptio Medical Technologies, Kaysville, UT) and relieved by pigtail catheter insertion and drainage. This case presented at a pediatric intensive care unit at a university-affiliated hospital. Our patient was an 18-month-old boy with short gut syndrome and subsequent end stage liver disease secondary to total parenteral nutrition cholestasis and respiratory syncytial virus-induced respiratory failure/acute respiratory distress syndrome. The patient was receiving hyperalimentation through a right-sided subclavian central venous catheter. Acute decompensation in hemodynamics and clinical exam prompted suspicion a right hemithorax abnormality. Portable plain films were unable to clarify collection or consolidation/collapse. Use of the bedside vascular imaging system was able to document a hydrothorax. Pigtail catheter insertion led to drainage of 305 cc of hyperalimentation, with immediate recovery of hemodynamic and respiratory function. The child continued to improve and eventually achieved extubation. He currently awaits liver transplantation. Although the PunctSURE ultrasonic vascular imaging system is intended as a vascular access adjunct, its resolution, portability, and ease of use make it a useful diagnostic tool in the pediatric intensive care unit setting for localization and drainage of a chest-based fluid collection.
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