Hydrothorax After Inadvertent Placement of a Central Venous Catheter in the Left Pericardiophrenic Vein

Abstract

after inadvenent placement of a central venous catheter in the left pericardiophrenic vein. J Intensive Care hfed 1994;9257-260. ~~~ ~We present 2 patients in whom the left pericardiophrenic vein (LPCW) was accidentally cannulated during catheterization of the left internal jugular vein (IJV). ?he final position of the catheter was confirmed by chest radiography and intravenous contrast medium. In both patients, the straight end of the guide wire was used during insertion of the catheter. In 1 patient, the tip of the catheter perforated the LPCW, producing a left hj-drothorax. T h i s malposition of a central venous catheters (CVC) can be prevented by routine use of the "J" end of the guide wire. In the event of misplacement of the catheter into the LPCPV, it must be repositioned to avoid potentially serious complications.'Chief, Central venous catheterization is the most common invasive procedure performed in intensive care units (ICUs). It is used not only for monitoring central venous and pulmonary pressures, but also to replace fluids and to provide a route for parented nutrition, drugs, hemodialysis, and emergency pacemakers. From the various techniques described for these purposes, the posterior approach of the internal jugular vein (IJV) has been our route of choice since it was reported more than 20 years ago [l]. This procedure can be considered almost free of major complications provided that it is practiced by trained ICU physicians following a strict and welldefined protocol. However, despite the skill and experience of the operator, serious complications, such as pneumothorax, cardiac perforation, and tamponade, may occur, even after a successful cannulation of the IJV due to inadvertent migration of the catheter to an improper final position [2-8).\Qe present 2 patients admitted to our ICU in whom the left IJV was cannulated, and a final position of the central venous catheter (CVC) into the left pericardiophrenic vein (LPCW) was demonstrated. In patient 1, the tip of the CVC perforated into the left pleural space, leading to a hydrothorax.Case Reports Patient 1. A 23-year-old woman with the diagnosis of myasthenia gravis was admitted to the ICU because of difficulty with mastication, diglutition, sialorrhea, progressive muscle weakness, ineffective cough, shallow breathing, and restlessness. She had been taking 30 mg pyridostigmine every 4 hours and prednisone 50 mg every other day during the previous year. Her blood pressure was 85/55 mm Hg. Temperature was 36.5"C, and her pulse rate was 110 beats per minute. The rest of her physical examination was unremarkable. Arterial blood gas analysis showed: pH, 7.32; PaCO,, 48 mm Hg; PaO,, 50 mm Hg (room air); and HCO,, 14 mEq/L. An edrophonium test was negative, and a cholinergic

A Rare Central Venous Catheter Malposition: A Case Report

“…Trunjillo described two cases of accidental placement of a central venous catheter in the left pericardiophrenic vein (6). Leang reported a case of accidental placement of the central venous catheter in the plural cavity (7).…”

“…Turi reported a case of catheter placement at the anterior mediastinum, following superior vena cava perforation ( 5 ). Trunjillo described two cases of accidental placement of a central venous catheter in the left pericardiophrenic vein ( 6 ). Leang reported a case of accidental placement of the central venous catheter in the plural cavity ( 7 ).…”

A Rare Central Venous Catheter Malposition in a 10-Year-Old Girl

“…A variety of rare complications such as perforation of the left brachiocephalic vein and massive hemothorax, chylothorax, internal mammary artery malposition of catheter, and inadvertent placement of a CVC in the left pericardiophrenic vein have been reported previously [ 5 – 8 ].…”

Accidental placement of central venous catheter into internal mammary vein: A rare catheter malposition

“…Trunjillo described two cases of accidental placement of a catheter in the left pericardiophrenic vein. [ 5 ] Leang reported a case of accidental placement of the catheter in the plural cavity.…”