Bilateral chylothorax as a complication of internal jugular vein cannulation

Abstract

Central venous catheterization is one of the most prevalent procedures in the Intensive Care Unit. Complications are reported in about 15% of the patients and usually comprise of infection, arterial puncture, malpositioning, pneumothorax, local hematoma, hemothorax, and so on. Chylothorax is a rare complication of this procedure. We present a 42-year-old lady, who developed bilateral massive chylothorax after cannulation of her left internal jugular vein (IJV), due to direct injury to the thoracic duct during the procedure. The patient was successfully managed with bilateral chest tube drainage and omission of oral feeds for four days. Development of bilateral chylothorax as a complication of IJV cannulation is rare, but merits reporting, in view of a large number of central venous cannulations being undertaken. Critical care professionals should be aware of this rare complication of a common procedure to facilitate early identification and institute appropriate therapy.

Thoracic duct cannulation during left internal jugular vein cannulation: A case report

“…Conversely, the amount of chyle is significantly reduced if patients are immobilized, starved, or constantly suctioned with a nasogastric tube. This is why bowel rest is used as a treatment for chylothorax[ 6 , 7 ].…”

Chylothorax after off-pump coronary artery bypass graft surgery: Management strategy

“…Unilateral as well as bilateral chylothorax has been reported after central venous cannulations through neck vessels. [ 17 ]…”

Pitfalls in internal jugular vein cannulation

“…Pneumothorax, pneumomediastinum, chylothorax, tracheal injury, hydrothorax, and air embolism are among the multiple pulmonary complications seen during a CVC insertion[ 6 , 15 ]. Cardiac complications include premature atrial and ventricular contractions, injury to the tricuspid valves, perforation of the right ventricle, and cardiac tamponade.…”