HOT TIPS

Following a review of the deaths of four babies due to cardiac tamponade associated with the presence of a central venous catheter, the UK department of health recommended in 2001 that:

“Until further investigation is undertaken concerning the ideal positioning of the catheter tip all central venous catheters inserted specifically for parenteral nutrition in this age group should be sited outwith the cardiac chambers.”

This was consistent with guidance in other countries. It was further recommended that:

“If there is suspicion that the line is in the atrium it should be repositioned.”

There was little evidence available on which to base an estimate of the frequency of this complication or to balance the risks and benefits of any policy decision about alternative line positions. National audit was recommended. An inevitable side effect of this policy has been that some infants are now subjected to repeated x rays with extra line breaks for contrast injections and have their dressings removed and replaced …