Bilateral hydrothorax and hydromediastinum after a subclavian line insertion

Abstract

Key wordsCOMPLICATIONS; hydrothorax; VEINS: cannulation, subclavian, complications.Since the introduction of central venous catheterization to clinical practice in 1945, t the technique has been widely used for the management of severely ill and injured patients. The subclavian route has gained popularity among anaesthetists because of easy access, reliability and catheter tolerance by conscious patients. The procedure is not without complications. Most reviews report complications in less than five per cent of cases, 2 but in one series the incidence of fatal complications was 1.4 per cent. 3The reported hazards of central venous catheterization include venous laceration, 4 haematoma formation,5 arterial puncture,6 catheter embolism,7From the Department of Anesthesiology, King Faisal University, King Fahd Hospital, P.O. Box 2208, A1 Khobar 31952; S audi Arabia; where correspondence should be addressed to Dr. Naguib.Homer's Syndrome with vocal cord paralysis, 8 pneumothorax, hydrothorax, 9 haemothorax, subcutaneous emphysema, arteriovenous fistula, brachial plexus injury, air embolism, 1~ thoracic duct injury,l~ hydromediastinum, t2 laceration of vertebral artery, 13 thrombus formation, 14 cardiac tamponade, 15 tracheal puncture, 16 and local and systemic infection. ~7The occurrence of bilateral hydrothorax following unilateral subclavian catheterization has not been previously reported.We report a patient who presented with bilateral hydrothorax following extravasation of the central venous line infusion into the mediastinum. Case reportA 28-year-old male presented to the emergency room with a fractured pelvis, fractured left tibia and fibula and internal haemorrhage, after a road traffic accident. He was in shock with blood pressure of 9.3/6.6 kPa (70/50 mmHg), and pulse rate of 145/ minute. After resuscitation, the patient was taken to the operating room for exploratory laparotomy under general anaesthesia, and the right internal lilac artery was ligated. During surgery, the anaesthetist found that the single intravenous line was inadequate to replace blood loss. He inserted a 14 gauge 8.3 cm angiocath into the left subclavian vein for fluid replacement. Three units of blood were transfused through the subclavian cannula during the operation. A chest x-ray taken postoperatively showed no abnormality. The patient was transferred in a stable condition, to the intensive care unit for observation. BP was 14.9/9.3 kPa (112/70 mmHg) and heart rate 100/minute.Three hours later, he again became tachycardiac and hypotensive with a heart rate of 136/minute and BP 12/9.3 kPa (90/70 mmHg). The respiratory rate was 34/minute. A diagnosis of hypovolemia was CAbl ANAESTH SOC J 1985 / 32: g / pp412-4

Hydromediastinum associated with a peripherally inserted central venous catheter in a newborn infant

“…5,7,8,12 In our case, the development of hydromediastinum resulted in acute respiratory distress. A chest radiograph showed a widened mediastinum, and sonography revealed echo-free space around the thymus and heart.…”

“…Patients with hydromediastinum, which is often accompanied by hydrothorax, have symptoms such as chest pain, dyspnea, nausea, vormitus, and hypotension. [5][6][7][8][9][10][11][12][13][14] Plain radiographic examination shows a widened mediastinum with or without a misplaced central venous catheter. 5,7,8,10-14 Contrast medium injec- tion via the central venous catheter can reveal abnormal location of the catheter tip and extravasation of the contrast medium into the mediastinum.…”

Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion—A Case Report and Review of Relevant Literature

“…Naguib et al [26] described a case of hydromediastinum and bilateral hydrothorax after a subclavian line insertion in a 28-year old male after multiple fractures due to motor vehicle accident. The left subclavian vein was cannulated intraoperatively.…”

Bilateraler Hydrothorax mit Hydromediastinum nach akzidenteller Katheterdislokation

“…Dazu gibt es in der Literatur weitere Fallberichte [3,5,7,9]. Es hängt dann von Zeitdauer und Infusionsvolumen ab, wann dieses klinisch sichtbar wird.…”

“…Dabei ist bei Perforation mit der Spitze neben der Verletzung der Venenwand auch die der Pleura parietalis möglich, welches dann zu einem Hydro-oder Infusionsthorax führt. Naguib et al [7] Vermeiden lassen können sich solche Komplikationen durch eine tägli-che gewissenhafte Inspektion der Einstichstelle, eine sichere Fixierung der Katheter an der Hautoberfläche und regelmäßige Röntgen-Kontrollaufnahmen sowie die Aspiration von Blut aus den proximalen Schenkeln der Mehrlumenkatheter.…”