Krwawienie do jamy opłucnowej jako powikłanie cewnikowania żyły podobojczykowej kaniulą dializacyjną — opis przypadku

Abstract

We present the case of a 39 year-old male patient admitted to ICU with symptoms of acute metabolic acidosis. He was investigated for the presence of methanol and glycol. Conservative treatment was initially started, followed by haemodialysis. During insertion of a temporary haemodialysis catheter in a location of Haapaniemi and Slatis, the patient was conscious but restless; therefore sedation was required to continue the procedure. After three hours of haemodialysis, the patient's general condition suddenly deteriorated. Hypovolemic shock and acute respiratory distress led to hypothesis of right haemothorax, which was rapidly confirmed by angio-CT examination. Trachea was intubated, drainage of right pleura was performed and aggressive fluid treatment begun. The patient was admitted to the operating theatre, and thoracotomy with reconstruction of damaged right venous angle was carried out. After the operation, the patient was transferred to ICU. He was mechanically ventilated and remained haemodynamically unstable. Although fluids and blood-made concentrates were transfused and catecholamines continuously administered, his clinical condition deteriorated and finally the patient died. We found two independent causes of this fatality: hypovolemic shock and acute extrinsic metabolic acidosis. However, this paper focuses on the problem of the iatrogenic complication, which was haemothorax. In the literature there are described examples of such cases. Authors emphasise the most traumatic moment of cannulation as being insertion of the guidewire and dilator to perform a tunnel for the catheter. Puncture by needle and localisation of the central vein results in fewer complications. Furthermore, we strongly recommend monitoring patients after central veins cannulation. All sudden deteriorations in clinical condition should be followed by meticulous diagnosis for the presence of this life-threatening complication.

Treatment of a central venous perforation caused by dialysis intubation using coils and cyanoacrylate glue: A case report

“…A total of 13 case reports on central venous perforation caused by dialysis catheterization published between 2007 and 2018 were reviewed (Table I) (2–9,11–15). Among them, 8 patients presented with hemothorax and HS (2,3,5,7,8,12–14), and 1 patient died despite rescue after surgery (3).…”

“…As presented in Table I, among the 13 cases reported from 2007 to 2018, 4 cases underwent thoracotomy (2–5), 1 case underwent thoracoscopic surgery (6), 3 cases received covered stents (7–9), 1 case received coil embolization (11), 3 cases received conservative treatment (12–14) and 1 case received coil combined with gel embolization (15). Of all of the cases, one patient died after thoracotomy (3). In the present case, therapeutic strategies were required to address the following two important issues.…”

Injury of the left brachiocephalic vein with hematoma and right sided pneumothorax after the insertion of a dialysis catheter

“…The hemorrhage may occur at many stages of the procedure. The selection of the catheter and the method of its introduction reduce the number of complications [1]. In our case the catheter used was too large and too stiff, so that it did not settle in the upper vena cava, pierced the vessel and entered the pleural cavity.…”

“…In our case the catheter used was too large and too stiff, so that it did not settle in the upper vena cava, pierced the vessel and entered the pleural cavity. Both during the procedure and after its completion, any deterioration of the patient’s general condition should arouse suspicion of this complication [1]. Quickly undertaken diagnostics and treatment save the patient’s life.…”

Placement of a Subclavian Tunneled Hemodialysis Catheter with the Patient’s Arm Raised May Reduce the Risk of Complications: Two Cases Report

“…In these patients, the right subclavian vein could serve as an alternative route, although it should be used as a last resort ( 3 ). The right subclavian vein often forms a right angle with the vena cava in some patients and can result in vascular injury during the insertion of a dilator or peel-away sheath ( 4 ). Elevation of the patient’s arm can change acute insertion angle to obtuse and may prevent such injuries.…”