• cardiac tamponade
• catheterisation
• central venous
• complications
• infant

• CV, central venous
• PCE, pericardial effusion
• PN, parenteral nutrition
• PVC, poly(vinyl chloride)
• UVC, umbilical venous catheter

Central venous (CV) lines have been the subject of much professional debate and public exposure in the UK following an enquiry into the deaths of four children in Manchester as the result of cardiac tamponade. One of the recommendations of this review was that CV line tips should not be placed within the cardiac outline.¹ This has been the recommendation of CV line manufacturers for some time.

In this issue, Beardsall et al report a retrospective questionnaire survey of pericardial effusion (PCE) and tamponade associated with percutaneously inserted central lines, together with a survey of current practice in percutaneously inserted central line use in neonatal units around the UK.² They compare the incidence of PCE in units with different approaches to the use of percutaneously inserted central lines. Despite likely ascertainment and response bias, and unknown confounders, this study adds an important piece to the complex puzzle of PCE. Their incidence of PCE of 1.8% in percutaneously inserted central lines is at the upper end of that reported in case series of 0.5–2.0%.³ Most PCE occurred in units aiming to place the line tip in the caval veins; the risk was greatest in units with the lowest use of CV lines. The most important conclusion of this study is that, with the current approach to positioning of long lines, an attempt to site the line tip in the caval veins (rather than the right atrium) is not associated with a reduction in incidence of PCE.