Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery

Wong, Kevin; Marks, Barry A.; Qureshi, Anwer; Stemm, Joseph J.

doi:10.1213/xaa.0000000000000323

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…Accidental vein perforation or injury to adjacent structures often results in catastrophic results, even death, and usually these patients were treated with embolization, spring coil or stent graft blocking, thoracoscopy, or open heart surgery. [7,9–13] In our study, when venous perforation was confirmed in patients 1 and 2, the catheter was maintained for 2 weeks and then adjusted under DSA guidance after the false lumen outside the catheter formed, and both patients underwent uneventful hemodialysis later. When the catheter was withdrawn immediately after venous perforation was confirmed in patient 3, massive hemorrhage and hemothorax occurred.…”

Section: Discussionmentioning

confidence: 69%

Management of venous perforation during central venous catheterization in hemodialysis patients

De-jun²,

Wang³

et al. 2019

Medicine

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Rationale: In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage. Patients concerns: Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis. Diagnoses: Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed. Interventions: In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed. Outcome: In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained. Lessons: When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.

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Section: Discussionmentioning

confidence: 69%

Management of venous perforation during central venous catheterization in hemodialysis patients

De-jun²,

Wang³

et al. 2019

Medicine

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“…Common popular treatment options are surgical repair by VATS [5][6][7] and endovascular repair, embolization, balloon tamponade, etc. [2,8,9,13].…”

Section: Discussionmentioning

confidence: 99%

“…Often, the preferred location for catheter access is the right internal jugular vein, for its straighter course into the superior vena cava and a reduced risk of malposition and thrombosis [2][3][4]. During the insertion of this catheter, a stiff dilator is used, which sometimes can lead to serious vascular injuries ultimately causing massive hemothorax, hypotension, cardiac arrest, or even death [5][6][7]. This usually happens in those patients who are on hemodialysis for a longer period of time and patients with central venous occlusive pathology (due to adhesion from repeated lines) [1,2,8].…”

Section: Introductionmentioning

confidence: 99%

“…This usually happens in those patients who are on hemodialysis for a longer period of time and patients with central venous occlusive pathology (due to adhesion from repeated lines) [1,2,8]. The common treatment options are surgical repair by open thoracotomy, video-assisted thoracoscopic surgery (VATS) [5][6][7], median sternotomy, or endovascular repair [9,10]. In this case report, the right brachiocephalic vein injury led to massive hemothorax in the right pleural cavity, which was successfully managed through median sternotomy.…”

Section: Introductionmentioning

confidence: 99%

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Brachiocephalic Vein Injury Leading to Massive Hemothorax Following the Insertion of a Tunneled Dialysis Catheter Requiring Surgical Intervention for Repair: Report of a Rare Case

Parvez¹,

DasGupta²,

Hoque³

et al. 2022

Cureus

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Dialysis catheters are commonly used tools for patients requiring hemodialysis. A dilator with a large caliber is used to insert such a catheter, which in turn can result in serious vascular injury leading to rare complications like hemothorax. Common treatment options for such vascular injuries comprise surgical repair by thoracotomy or video-assisted thoracoscopic surgery (VATS) and endovascular repair. We herein report a case of a brachiocephalic vein injury and massive right-sided hemothorax following the insertion of a tunneled dialysis catheter in the right internal jugular vein, treated successfully by our team at Square Hospitals Ltd.

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“…[1] Some of these complications can be fatal. [2,3] Malposition of the jugular or subclavian double-lumen central catheter is not an uncommon complication. [3–5] Femoral double-lumen central venous hemodialysis catheter malposition in adults is rare, [6–8] and most cases are acute, occurring right after the catheter insertion, but delayed malposition was found in our case.…”

Section: Discussionmentioning

confidence: 99%

Delayed malposition of a double-lumen hemodialysis catheter that caused hemorrhage and hypovolemic shock

et al. 2019

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Rationale:Double-lumen hemodialysis catheters are commonly used as temporary hemodialysis routes. Complications include infection, thrombosis, cardiac arrhythmia, entrapped guide wire, and malposition. We report a rare complication of delayed hemodialysis catheter malposition that caused retroperitoneal hemorrhage and hypovolemic shock during hemodialysis.Patient concerns:A 72-year-old female patient who was receiving hemodialysis was referred to our emergency department because of general discomfort and decreased blood pressure (BP) after her regular hemodialysis. She had undergone surgery for a left forearm arteriovenous pseudoaneurysm and received a temporary hemodialysis catheter insertion via the left femoral vein 2 weeks before. The initial blood examination revealed a mildly decreased baseline hemoglobin level (7.2 g/dL) and hyperkalemia (5.9 mmol/L). Her BP recovered after fluid resuscitation. She was administered hemodialysis again, following which her BP reduced and a change in consciousness developed.Diagnosis:Chest and abdominal computed tomographies were performed to exclude acute vascular problems and showed a hemodialysis catheter tip protruding from the left iliac vein and hematoma in the left retroperitoneal space and pelvic cavity.Interventions:Intubation, fluid resuscitation, vasopressor administration, and blood transfusion were performed. She was admitted to the intensive care unit. The left femoral hemodialysis catheter was removed.Outcomes:Follow-up computed tomography revealed resolution of the retroperitoneal space hematoma. She was transferred to the ordinary ward 18 days later with a stable hemodynamic status. Unfortunately, she developed hospital-acquired pneumonia and arteriovenous shunt infection, and died from respiratory failure and sepsis on the 34th day in our hospital.Lessons:Femoral double-lumen catheter malposition is rare and potentially fatal. Emergency physicians should be aware of situations wherein a patient's BP declines markedly soon after a hemodialysis initiation.

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Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery

Cited by 8 publications

References 12 publications

Management of venous perforation during central venous catheterization in hemodialysis patients

Management of venous perforation during central venous catheterization in hemodialysis patients

Brachiocephalic Vein Injury Leading to Massive Hemothorax Following the Insertion of a Tunneled Dialysis Catheter Requiring Surgical Intervention for Repair: Report of a Rare Case

Delayed malposition of a double-lumen hemodialysis catheter that caused hemorrhage and hypovolemic shock

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