Fitter, Maureen

60y · Female·Cardiac tamponade due to ruptured heart due to total parenteral nutrition due to caecal polyp (surgically treated)

A 60-year-old woman died from cardiac tamponade caused by TPN fluid leaking into the pericardium through a PICC line inserted to provide nutrition following bowel surgery. The PICC line was inserted under image intensification with appropriate technique and placement at the SVC-right atrium junction. How the perforation occurred remains unclear—possibilities include migration after insertion, partial perforation with delayed extension, or other mechanisms. The diagnosis of cardiac tamponade was not made ante-mortem due to its rarity, non-specific presentation, and difficulty distinguishing it from other causes in a patient with severe bowel obstruction. Treatment provided by nursing and medical staff during the fatal deterioration was appropriate. This case highlights that cardiac tamponade from PICC lines is an extremely rare but known complication with non-specific symptoms and no simple diagnostic test, making prevention difficult even with optimal clinical practice.