Cardiac Tamponade from Central Venous Catheters

Défalque, Ray J.; Campbell, Christina

doi:10.1097/00000542-197903000-00021

Cited by 119 publications

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“…This has been reported. 15 It is suggested that the occurrence of bilateral hydrothorax may have been due to the shift of the extravasated fluid from the mediastinum through the thin mesothelium of the parietal pleurae, facilitated by the pressure differences between the two compartments. The delayed onset of symptoms could also be accounted for by changes in intravascular volume over time.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral hydrothorax and hydromediastinum after a subclavian line insertion

1985

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Key wordsCOMPLICATIONS; hydrothorax; VEINS: cannulation, subclavian, complications.Since the introduction of central venous catheterization to clinical practice in 1945, t the technique has been widely used for the management of severely ill and injured patients. The subclavian route has gained popularity among anaesthetists because of easy access, reliability and catheter tolerance by conscious patients. The procedure is not without complications. Most reviews report complications in less than five per cent of cases, 2 but in one series the incidence of fatal complications was 1.4 per cent. 3The reported hazards of central venous catheterization include venous laceration, 4 haematoma formation,5 arterial puncture,6 catheter embolism,7From the Department of Anesthesiology, King Faisal University, King Fahd Hospital, P.O. Box 2208, A1 Khobar 31952; S audi Arabia; where correspondence should be addressed to Dr. Naguib.Homer's Syndrome with vocal cord paralysis, 8 pneumothorax, hydrothorax, 9 haemothorax, subcutaneous emphysema, arteriovenous fistula, brachial plexus injury, air embolism, 1~ thoracic duct injury,l~ hydromediastinum, t2 laceration of vertebral artery, 13 thrombus formation, 14 cardiac tamponade, 15 tracheal puncture, 16 and local and systemic infection. ~7The occurrence of bilateral hydrothorax following unilateral subclavian catheterization has not been previously reported.We report a patient who presented with bilateral hydrothorax following extravasation of the central venous line infusion into the mediastinum. Case reportA 28-year-old male presented to the emergency room with a fractured pelvis, fractured left tibia and fibula and internal haemorrhage, after a road traffic accident. He was in shock with blood pressure of 9.3/6.6 kPa (70/50 mmHg), and pulse rate of 145/ minute. After resuscitation, the patient was taken to the operating room for exploratory laparotomy under general anaesthesia, and the right internal lilac artery was ligated. During surgery, the anaesthetist found that the single intravenous line was inadequate to replace blood loss. He inserted a 14 gauge 8.3 cm angiocath into the left subclavian vein for fluid replacement. Three units of blood were transfused through the subclavian cannula during the operation. A chest x-ray taken postoperatively showed no abnormality. The patient was transferred in a stable condition, to the intensive care unit for observation. BP was 14.9/9.3 kPa (112/70 mmHg) and heart rate 100/minute.Three hours later, he again became tachycardiac and hypotensive with a heart rate of 136/minute and BP 12/9.3 kPa (90/70 mmHg). The respiratory rate was 34/minute. A diagnosis of hypovolemia was CAbl ANAESTH SOC J 1985 / 32: g / pp412-4

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Section: Discussionmentioning

confidence: 99%

“…15 Meticulous technique, awareness of the complications and close observation of the patient are necessary in the management of a central venous line. …”

Section: Discussionmentioning

confidence: 99%

Bilateral hydrothorax and hydromediastinum after a subclavian line insertion

1985

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“…-La punta del catéter localizado en la aurícula daña el endocardio en forma progresiva con cada contracción auricular, posteriormente la punta es fijada a través de un trombo (1,15,17); raramente la punta es atrapada por los pilares del corazón. Posteriormente, el catéter lentamente necrosa la pared auricular; esto es más frecuente en cavidades distendidas o con infiltración grasa (15).…”

Section: Discusionunclassified

“…Una presión de infusión entre 15 y 20 cm de H 2 0 2 una inyección rápida de contraste (15), la irritación repetida de soluciones hiperosmolares (19), la guía metálica, el dilatador o la sobreinserción de un catéter de cola rígida puede dañar o perforar la pared del vaso o del corazón (17).…”

Section: Discusionunclassified

“…Una vez que la perforación se ha producido el cuadro de taponamiento se desarrolla rápidamente, pues bastan de 100 a 300 ml para que el taponamiento sea fatal. En una serie de autopsias de pacientes que presentaron paro cardíaco súbito minutos a horas después de la canulación se demostró perforación cardiaca pese a no presentar cuadro de taponamiento (15).…”

Section: Discusionunclassified

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Cateterismo venoso central y perforación de miocardio. Presentación de un caso.

Villavicencio¹,

Hurtado²

2013

Rev Med Hered

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SUMMARYThe use of central venous catheters has a wide use in our hospitals, but it is not exempt from complications. We report a 18 years old woman who had one of this life involved complication. The patient died and necropsy she was diagnosed as follow: perforation of miocardium and pericardial tamponade. The possible mechanism of perforation it was a gradual form which has several causes. It is very important to understand the different forms of perforation and also to evaluate frequently every central venous catheter to prevent all these fatal ocurrences. ( Rev Med Hered 1998; 9:119-122 ). INTRODUCCIONEl uso del catéter endovenoso tanto para la administración de fluídos como para el monitoreo de la Presión Venosa Central, tiene gran aceptación en nuestro medio. Sin embargo no está exento de complicaciones, siendo las más severas: la laceración y penetración de la pared del miocardio (1), y el taponamiento pericárdico por perforación del miocardio (2).Cuando una vena central es caracterizada, al desplazar la punta del catéter, ésta puede perforar la vena a cualquier nivel e independientemente del lugar desde donde se localice el otro extremo.De ocurrir este evento podría producirse un hidromediastino, un hidrotórax o más grave aún un taponamiento pericárdico (3). En la cateterización cardiaca la punta del catéter cruza las cámaras cardíacas, existiendo también riesgo de perforación de perforación con posterior taponamiento pericárdico, o de inducción de arritmias (4). Aún después que el catéter haya sido colocado y fijado adecuadamente, la punta del catéter puede ser movilizada y/o desplazada durante: el movimiento de la extremidad contigua, durante la rotación del cuerpo respecto a dicha extremidad, durante el movimiento de cuello (5), o durante el masaje cardiaco (6); durante estos movimientos la punta del catéter entra en forma repetida en contacto con la pared del vaso y/o del miocardio pudiendo producir la perforación de cualquiera de éstas.A continuación reportamos un paciente que presentó una de estas complicaciones.COMUNICACION CORTA

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