Massive hemothorax immediately after removal of central venous catheter -A case report-

Abstract

Hemothorax is a possible immediate complication of central venous catheterization. We experienced a patient who suffered from massive hemothorax 72 hours after right subclavian venous catheterization. A 29-year-old female patient with Marfan's syndrome underwent the Bentall's operation and aortic arch replacement with an artificial graft, which was performed uneventfully. She recovered favorably in the intensive care unit and was transferred to the general ward on postoperative day 3. Immediately after the removal of the catheter in the general ward, massive hemothorax developed and emergent thoracotomy should have been performed to control bleeding. We report this case to re-emphasize the careful monitoring even after removal of central venous catheter and the need for ultrasound guidance during insertion of central venous catheters.

Hemothorax Occurring After Central Venous Catheter Removal: A Case Report

“…A third one was also reported in Korea, where a hemothorax occurred ten minutes after the removal of the subclavian catheter. The latter reports the reason to be an injury to the superior vena cava, as found after thoracotomy for treatment [3]. However, in our case, the bleeding stopped so no surgical intervention was done to further investigate the reason.…”

“…There is still no explanation behind the late hemorrhagic complications of central venous catheterization, but suggestions included procedure-related injuries and erosion of the vessel wall by the catheter itself or by hyperosmolar solutions [3,9,10]. We believe that the difficult insertion of the central venous catheter may have caused vessel erosions, and the altered bleeding diathesis by the antiplatelet is the reason behind our patient's rare occurrence.…”

“…We believe that the difficult insertion of the central venous catheter may have caused vessel erosions, and the altered bleeding diathesis by the antiplatelet is the reason behind our patient's rare occurrence. Therefore, ultrasound-guided central venous cannulation can be very useful, with reductions in the failure rate from 55% to 8% and the complication rate from 41% to 4% were reported when compared to anatomic landmark-based techniques [3]. Hence, we suggest that proper insertion techniques be applied, and training to use ultrasoundguided techniques can prevent the occurrence of such fatal complications.…”

“…Central venous catheterization, first described in 1952, is a technique used for several indications such as the need for fluid resuscitation, blood transfusion, drug infusion, hemodynamic monitoring and to establish safe and large bore access for patients with difficulty inserting a peripheral intravenous (IV) access [1]. Potential complications of this procedure include insertion site pain or hematoma, misplacement, infection, vessel laceration or dissection, thrombosis, and pneumothorax that may require chest tube insertion [2][3][4]. However, some complications may be caused by its removal mainly air embolism, catheter fracture embolism, dislodgement of thrombus or fibrin sheath, and bleeding [5].…”

Migration of silicone catheter into pleural space: a case report

“…Over-the-wire catheter exchange or direct catheter removal are the treatment choice for the obstructed TIVAP. However, any intervention affecting the dysfunctional catheter, including removal or exchange may lead to possible lethal hemothorax or hemopericardium without proper closure of the chronic tract, which had been reported in previous reports [ 11 , 12 ]. Leaving the TIVAP without further utilization did not cause any adverse effect; therefore, this option was also provided.…”