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Thoracocentesis in pericardial and pleural effusion caused by central venous catheterization: a less invasive neonatal approach?

SIR—I read with great interest the recent article ‘Thoracocentesis in pericardial and pleural effusion caused by central venous catheterization: a less invasive neonatal approach’ (1). The case report describes an extreme low birth weight infant who suffered bilateral pleural and pericardial effusion as a complication of central venous catheter. Timely diagnosis and drainage of the pleural effusion has saved the life of the reported patient. However, the author has recommended that drainage of pleural effusion is less invasive than that of pericardial effusion. They also write that if pleural effusion is drained there may be no need to drain the pericardial effusion. Before agreeing with this viewpoint as such, I would suggest further clarification because of several reasons. If a patient exhibits signs of cardiac temponade, a pericardial effusion should be drained in order to establish adequate cardiac output. If the cardiac output is adequate and there are no signs of tamponade, pericardiocentesis may not be required. They also wrote that pericardial effusion seemed to resolve spontaneously via the functioning pleural drainage indicating that a direct communication existed between the pleural and pericardial sac in their patient. They also recommend that the catheter tip should be accurately localized in the superior/inferior vena cava and prevented from entering the right atrium so that it does not impinge on the cardiac muscle. I agree with this statement but would want to state that portions of both inferior as well superior vena cava are intrapericardial (2). In order to avoid the occurrence of cardiac tamponade, besides positioning the catheter outside the heart, it is also necessary to position the catheter outside the intrapericardial portion of these vessels and monitor for any evidence of migration during the hospital course (3). Ali M Nadroo M D Department of Pediatrics, Division of Neonatal ICU, New York Methodist Hospital, Brooklyn, NY 11215, USA (email: anadroo@yahoo.com, amn9006@nyp.org) References