Central venous catheter-induced pericardial effusion in a neonate: a case study and recommendations for practice.

Pericardial effusion (PCE) and tamponade as a complication of central venous catheters (CVCs) continues to occur in the neonatal population. It is imperative that clinicians managing neonates with CVCs practice vigilance regarding proper catheter tip location. Furthermore, it is of equal importance that clinicians have a high index of suspicion regarding the catheter tip location any time a neonate with a CVC has a clinical deterioration. It is clear that the ultimate outcome of PCE depends on rapid identifi cation and a quick response when pericardial tamponade occurs. PCE can occur any time during the duration of the catheter dwell time, and education of staff caring for neonates will assist in prevention and rapid treatment.

Pericardial conditions: signs, symptoms and electrocardiogram changes.

This article describes the anatomy and physiology of the pericardium and the signs and symptoms of acute pericarditis, pericardial effusion and cardiac tamponade. It illustrates the likely electrocardiogram findings in each of these conditions and discusses how the results, combined with patient history and physical examination, can help emergency nurses make accurate diagnoses.

Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications.

Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.

Metastases that interfere with circulation.

OBJECTIVES: To review the nursing implications of select circulatory problems caused by metastatic cancer. DATA SOURCES: Journal articles, research studies, and book chapters relating to circulatory problems associated with metastatic disease. CONCLUSIONS: During the metastatic process, tumor cells can interfere with circulation. As a result, circulatory impairments can range from life threatening to manifestations that may alter a person's quality of life. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have a responsibility to seek current knowledge about therapeutic and supportive care for persons experiencing circulatory alterations. Collaboration with colleagues can facilitate patient care in these clinical situations. Patient education can be supportive and may enhance optimal outcomes.

Malignant pericardial effusions: pathophysiology and clinical correlates.

Cardiac tamponade resulting from malignant pericardial effusions is a life-threatening oncologic emergency. As many as 21% of all patients with cancer may be at risk for this complication. A malignant effusion often signifies progressing disease, creating stress and anxiety for patients and their families. By understanding the pathophysiology and pertinent risk factors, the nurse may identify an effusion before it progresses to cardiac tamponade. The goal of management is removal of fluid, restoration of hemodynamic functioning, and prevention of fluid reaccumulation. Emotional support and reassurance, as well as accurate information regarding the disease and treatment, also are critical in assisting patients to adapt to these changes in disease status.