Central Venous Perforation Despite Non-Kinking of Guide Wire and Clinically Uneventful Catheter Placement

Case Report

Austin Crit Care J. 2020; 7(1): 1031.

Central Venous Perforation Despite Non-Kinking of Guide Wire and Clinically Uneventful Catheter Placement

Schummer W¹* and Sakka SG²

¹Department of Anesthesiology, Helios Hospital Ueberlingen, Germany and Friedrich Schiller University Jena, Germany

²Department of Anesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Medical Centre Merheim, Cologne, Germany

*Corresponding author: Wolfram SCHUMMER, Department of Anesthesiology, Helios Hospital Ueberlingen, and Friedrich Schiller University Jena, Germany

Received: December 23, 2019; Accepted: January 20, 2020; Published: January 27, 2020

Abstract

Complication rate by central venous catheterization which is up to 15% may be related to numerous factors, e.g. physician’s experience, site of placement and use of ultrasound. Here, we present two critically ill patients with - ultrasoundguided in one and with landmark technique in the other - simultaneous placement of a central venous catheter and a hemodialysis catheter in whom despite nonkinking of the guide wire and uneventful placement in both cases resulted in a mediastinal malposition. Since potentially life-threatening complications may be associated with the misplacement further research is required.

Keywords: Central venous catheter; Vessel perforation; Complications

Introduction

Complication rate by central venous catheterization which is up to 15% may be related to numerous factors, e.g. physician’s experience, site of placement and use of ultrasound [1-3]. Here, we present two patients with - ultrasound-guided in one and with landmark technique in the other - simultaneous placement of a central venous catheter and a hemodialysis catheter in whom the latter despite uneventful placement in both cases resulted in a mediastinal malposition.

Case Reports

A 30-year old female (BMI 26.6 kg m-2) was transferred to our ICU requiring vasopressor support and renal replacement therapy. Due to clinical circumstances, a 3-lumen central venous catheter (CVC) and a double-lumen hemodialysis catheter (11F, length 20 cm) were placed. Under real-time ultrasound-guidance, the left internal jugular vein (LIJV) was punctured uneventfully twice. Ultrasound confirmed both guide wires within the LIJV. After advancement of the catheters to their final position blood could be aspirated over all lumen. Intravascular ECG was used for placement of the 3-lumen catheter, which was fixed on the skin level at 21 cm. Chest X-ray showed old and new catheters in place, however, a new homogenous loss of transparency of the left hemi-thorax was found (Figure 1A). Since injection of 0.9% saline into the hemodialysis catheter prior to renal replacement therapy caused retrosternal pain, computed tomography (CT) was performed immediately. The dialysis catheter was found with its tip in an extra luminal position in the anterior mediastinum. Fluid was seen close to the catheter tip (Figure 1B). A lesion of the aorta and a pericardial effusion were excluded. The massive left-sided pleural effusion required a chest tube which drained serous fluid. The hemodialysis catheter was removed uneventfully.

Citation: Schummer W and Sakka SG. Central Venous Perforation Despite Non-Kinking of Guide Wire and Clinically Uneventful Catheter Placement. Austin Crit Care J. 2020; 7(1): 1031.