Extravasation of TPN into the pleural space, a rare complication of central venous catheter placement: a case report

Abstract

Background: Complications associated with central venous catheters are well documented in the literature, most of which relate to catheter placement or infections. Nonetheless, on rare occasions, the catheter can erode the arterial wall, allowing medication, fluids, or even total parenteral nutrition to pass into the pleural space. Case presentation: We present the case of a 68-year-old male who was critically ill in the intensive care unit and required total parenteral nutrition. A central venous catheter was placed, and the patient’s condition improved. While in the intensive care unit, it became necessary to change the central line, and a new catheter was placed. Subsequently, he experienced respiratory distress and impaired oxygenation, with a significant pleural effusion. When the chest tube was placed, a milky-white fluid was detected, and subsequent tests revealed it to be an effusion of total parenteral nutrition. Following this event, the catheter was immediately changed, and with subsequent treatment, the patient recovered completely. Conclusion: Identification and management of central line complications are essential in patients with vascular access. These rare complications must always be considered in the differential diagnosis and recognized early to avoid potentially dangerous outcomes.