Cardiac tamponade from misplaced central venous line in pericardiophrenic vein

Haeften, Timon W. van; Pampus, Elizabeth C. M. van; Boot, H.; Schijndel, Robert J.M. Strack van; Thijs, L. G.

doi:10.1001/archinte.148.7.1649

Cited by 34 publications

(17 citation statements)

References 11 publications

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“…To the best of our knowledge, this unusual venous route of pulmonary artery catheterization cannulated from the right side has never been previously reported in the literature, although cases of cannulation from the left IJV with inadvertent placement of the pulmonary artery catheter into left pericardiophrenic vein have been published [9]. In another report, cannulation of central venous catheter in the left pericardiophrenic vein had led to cardiac tamponade due to vessel rupture [10]. …”

Section: Discussionmentioning

confidence: 99%

Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein?: a case report

Park

Sim

Lee

et al. 2014

Korean J Anesthesiol

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We report an extraordinary case in which the venous route for pulmonary artery catheterization was unusual. A 41 year-old woman with an end-stage liver disease underwent a living-donor liver transplantation. After induction of anesthesia, the pulmonary artery catheter was revealed to be advanced into the left brachiocephalic vein and then slipped into another vein that drains into the left brachiocephalic vein. In this case, we assumed that the catheter had most likely slipped into the left pericardiophrenic vein since the catheter follows the left heart border similarly to the route of this vein according to the chest X-ray. Patients with liver cirrhosis develop many collateral vessels and have enlarged veins due to portal hypertension, which makes this vascular route possible. We present this case for anesthesiologists to be aware of the possibilities of unusual venous route due to dilated collateral vessels especially in liver transplant patients.

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Section: Discussionmentioning

confidence: 99%

Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein?: a case report

Park

Sim

Lee

et al. 2014

Korean J Anesthesiol

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“…For those with deep tip location, arrhythmias, and myocardium injury were reported. 2–4 For those with shallow tip location, complications such as catheter-related thrombosis, catheter migration, brachial plexopathy, neurologic deficit, and cortical vein thrombosis were reported because of slow blood flow velocity could not dilute the infused mecication. 1,5–9 Adequate tip location could minimize the risk of catheter-related complication but the adequate tip location were remain debates because of the intravascular portion of catheter were free mobile within vessel.…”

Section: Discussionmentioning

confidence: 99%

“…1 Numerous complications were reported because of catheter migration that caused by inadequate tip location. Too deep catheter tip may lead arrhythmias, 2,3 heart injury, 4 and vessel perforation. 2 Too shallow tip location may cause migrated catheter to nearby vein and cause various clinical symptoms, including back pain, 5 brachial plexopathy, 6 neurologic deficit, 6 and cortical vein thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route?

et al. 2015

Medicine

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Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20 mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P = 0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P = 0.02), and longer implanted catheter length (P = 0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy.

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“…The aim should be to reposition the catheter immediately, even if there is the slightest doubt about the position, to avoid any complications and considering patient safety as opposed to wasting time on investigations that are merely diagnostic, require radiological expertise, exposes the patient to possible hazards from radiation, contrast media and a risk of myocardial ischaemia [2], pericardial tamponade [3] besides adding to costs. The aim should be to reposition the catheter immediately, even if there is the slightest doubt about the position, to avoid any complications and considering patient safety as opposed to wasting time on investigations that are merely diagnostic, require radiological expertise, exposes the patient to possible hazards from radiation, contrast media and a risk of myocardial ischaemia [2], pericardial tamponade [3] besides adding to costs.…”

mentioning

confidence: 99%