Hydrothorax after Central Venous Catheterization

Rudge, Chris; Bewick, M.; McColl, Ian

doi:10.1136/bmj.3.5870.23

Cited by 26 publications

(5 citation statements)

References 12 publications

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“…Arterial Puncture. [6][7][8][9][10][11][12] Procedure: Written informed consent was obtained after explaining the procedure and purpose of study to the patient during pre-anaesthetic visit. In the operating room after attaching the routine monitors, general anaesthesia was induced.…”

Section: Study Definitionsmentioning

confidence: 99%

Comparison Between Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Venous Catheterisation in Adults

Raphael¹,

Simon²,

Thankappan³

et al. 2016

jebmh

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BACKGROUND The Subclavian Vein (SV) is one of the preferred route for central venous catheterisation. There is limited data comparing the efficacy of Ultrasound (US) guided Supraclavicular (SC) and Infraclavicular (IC) approaches for SV cannulation in India. The purpose of this study was to compare the effectiveness of these procedures. METHODOLOGY We selected 130 patients aged ≥18 years (Mean age 59, men 57%) and recruited them equally into a supraclavicular and infraclavicular groups on alternate basis. Catheterisation was done by a single experienced anaesthesiologist using standard protocols. Information on age, sex, time for locating the vein, puncture time, number of attempts, catheter insertion time and incidence of complications were collected using a structured proforma. Data were analysed comparing the two groups using SPSS. RESULTS The mean time for locating the vein was 24 seconds (s) in the infraclavicular group which is significantly higher than that in the supraclavicular group, 17s (p<0.001). The puncture time was 54 s in the IC group and 40 s in the SC group (p=0.001). Catheterisation time was 132 s in the IC group and 120 s in the SC group (p=0.003). Number of multiple attempts was 22 in the IC group and 8 in the SC group (p=0.005). There were no complications and no guide wire misplacements in either group. CONCLUSION The supraclavicular approach for US-guided subclavian vein catheterisation in adults is clinically more advantageous in terms of shorter time for location, puncture time, catheterisation time, lower number of attempts & a potentially lower incidence of complications when compared to the infraclavicular approach.

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Section: Study Definitionsmentioning

confidence: 99%

Comparison Between Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Venous Catheterisation in Adults

Raphael¹,

Simon²,

Thankappan³

et al. 2016

jebmh

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show abstract

“…CVC and PICC may cause certain complications that can be divided into two categories: immediate and delayed [1] , [2] , [11] . Delayed complications are related to prolonged catheter use, including cardiac tamponade, catheter-related infection, unilateral and bilateral hydrothorax, and hydromediastinum [2] , [12] , [13] , [14] , [15] , [16] . However, these complications have been predominantly described in left-sided CVCs, and only two articles reported vascular erosion as a complication of the inserted central venous catheter for TPN [9] , [17] .…”

Section: Discussionmentioning

confidence: 99%

Hydromediastinum and hydrothorax as delayed complications of peripherally inserted central catheter used for total parenteral nutrition: A case report

Chica

Ballén

Aguillon

et al. 2021

International Journal of Surgery Case Reports

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Introduction Central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) may cause delayed complications, such as venous erosion, hydrothorax, or hydromediastinum. Vascular erosion is most frequently associated with left-sided CVC insertions. We report a case of hydropneumomediastinum and hydropneumothorax as a delayed complication of right-sided PICC used for total parenteral nutrition. Presentation of case A 77-year-old man with muscle-invasive urothelial bladder cancer underwent pelvic lymphadenectomy and radical cystectomy with uretero-ileostomy reconstruction (Bricker). The patient developed postoperative ileus, and thus, a right PICC was inserted for total parenteral nutrition. On postoperative day 8, he developed bilateral hydromediastinum, and bilateral thoracentesis was performed. After the procedure, he presented with respiratory and hemodynamic deterioration and was transferred to the intensive care unit for 12 days. The patient was eventually discharged and followed-up at the outpatient department. Discussion Ruptured SVC has been predominantly described in left-sided CVCs at the right angle of the junction of the left brachiocephalic vein and SVC. However, our patient is the second documented case of bilateral hydropneumothorax and hydropneumomediastinum as a delayed complication of a PICC used to administer total parenteral nutrition. Catheters may migrate from their initial position due to breathing, bloodstream flow dynamics, postural rotation, and neck movements. Chemical irritation of the vessel wall may be caused by hyperosmolar hyperalimentation fluid. Conclusion A right-sided vascular approach is preferred to avoid friction complications, and the tip should be placed at the lower third of the vena cava to prevent vascular erosion.

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“…We have reports of ipsilateral pleural effusion following misplaced central venous catheters. 9 10 There are a couple of rare cases being reported to have bilateral pleural effusion, but none had associated pneumomediastinum and a punctured subclavian vein. 11 12 Although likely communications between pleural and peritoneal cavities have been reported before, but little information exists in the literature about channels communicating between the two pleural cavities.…”

Section: Discussionmentioning

confidence: 99%

Bilateral pleural effusion and pneumomediastinum: rare complication resulting from punctured left subclavian vein following insertion of PICC line for total parenteral nutrition

2021

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This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.

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Hydrothorax after Central Venous Catheterization

Cited by 26 publications

References 12 publications

Comparison Between Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Venous Catheterisation in Adults

Comparison Between Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Venous Catheterisation in Adults

Hydromediastinum and hydrothorax as delayed complications of peripherally inserted central catheter used for total parenteral nutrition: A case report

Bilateral pleural effusion and pneumomediastinum: rare complication resulting from punctured left subclavian vein following insertion of PICC line for total parenteral nutrition

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