Cardiac Tamponade From CVP Catheter Perforation

Cardiac Tamponade as a Result of Infusion Therapy. A Potentially Amenable Complication of Central Venous Catheters

“…A sudden and otherwise unexpected deterioration in a patient receiving fluid through a central venous catheter, with rapidly developing heart failure, tachycardia, low blood pressure, and congestion of neck veins, should arouse suspicion (16). Larger amounts of infusion fluid aspirated from the catheter (lo), or from a cannula introduced into the pericardial sac (17) will confirm the diagnosis (14). In the present case, it should be noted that tht.…”

“…Coronary atheromatosis was significant, and the microscopic changes were those o f a myocardial infarct limited to a narrow zone around the puncture wound in the wall ofthe right ventricle and adjacent septum. Perforation of the heart associated with fatty infiltration of the myocardium has been reported (14), and it is possible, though not very likely, that local weakening of the heart wall played a pathogenetic part in the present case. We consider it more probable that infusion of fluids into the myocardium with trauma and backwards flow along the catheter for a considerable time before perforation was complete contributed to these changes.…”

“…Hydropericardium may manifest itself' soon after the catheter is inserted (4,5,14), or significantly more usually after a considerable time lag of hours, days, or even weeks, and after it has been used for infusion of large amounts of fluid, as in the present case (2,4,5,6,7,9,10,15,16). Heart movements around a misplaced cathetrr tip probably contribute to perforation.…”

“…This is a common experience (5,17,18). Blood contamination may be present but is usually not significant (7,14,15,16). These features suggest that haemorrhage through the puncture wound is very seldom of' pathogenetic significance.…”

Displacement of catheters inserted through internal jugular veins with neck flexion and extension

“…This displacement may have the following consequences (in order of severity): a) migration of the catheter into a jugular vein, or advancement of the catheter tip to the wall of the subclavian vein, brachiocephalic trunk or superior vena cava (all these situations may give false readings of central venous pressure); b) displacement of the tip of a Swan-Ganz catheter from pulmonary artery into a wedge position and vice versa; c) occurrence of ventricular irritability if a central venous catheter is displaced from the superior vena cava or right atrium into the right ventricle; when such a situation arises, ventricular irritability may be missinterpreted and a mechanical causative factor may be treated pharmacologically; d) chronic irritation of the wall of the central vein or heart cavities resulting in thrombosis or fatal endocarditis [22]; e) perforation of a central vein or of the right atrium by the catheter tip, followed by haemomediastinum and death [2,8,10,12,13,15,21,23], or perforation of the right ventricle by an electrode-catheter inserted for cardiac pacing [16].…”