Sir.—I read with interest the Radiological Case of the Month in the December 1991 issue of AJDC, concerning retrieval of hyperalimentation fluid from the cerebrospinal fluid in an infant with a central venous catheter in the inferior vena cava.1 I previously reported a virtually identical case 2 with a more catastrophic result. Although the authors stressed the importance of confirming catheter position, they failed to identify several other risk factors our patients held in common. Small patient size, increased solution hypertonicity, and the presence of congestive heart failure are related to caval thrombosis and the potential for retrograde flow into the epidural venous plexus. Avoidance of central nervous system damage requires vigilance in these high-risk situations, including consideration of periodic abdominal ultrasound to detect caval occlusion.
GREENHOLZ SK. Parenteral Nutrition Complications. Am J Dis Child. 1992;146(12):1421. doi:10.1001/archpedi.1992.02160240031012