Central Venous Catheter Vascular Erosions

Abstract

Central venous catheter (CVC) vascular erosions are difficult to diagnose, and they cause serious complications. From 1985 to 1987, ten patients receiving the surgical services at the University of Florida suffered CVC vascular erosions. By chest roentgenogram, nine CVC tips were in the superior vena cava (SVC), although three catheter tips abutted the lateral wall of the SVC. One catheter tip was in the right atrium. All patients had sudden onset of symptoms, the most common of which was shortness of breath. Initial diagnosis was respiratory insufficiency in five patients, cardiac failure in three patients, pulmonary embolism in one, and sepsis in one. Four patients required intensive care. Two patients suffered pericardial tamponade, and pleural effusions developed in eight patients. One patient died of cardiac arrest. The average time interval from CVC placement to onset of symptoms was 60.2 hours, and from the onset of symptoms to the time of diagnosis, the interval was 16.7 hours. The mean volume obtained at thoracentesis was 1324 ml and at pericardiocentesis was 250 ml.

Perforation of the superior vena cava 5 days after insertion of a central venous catheter through the left internal jugular vein

“…Perforation of the superior vena cava (SVC) is a rare but life-threatening complication, especially among critically ill patients, in whom the perforation may cause fatal hemothorax or hydrothorax. According to previous reports, SVC perforations are most often associated with left-sided CVC insertions and CVC tip malpositioning [2][3][4][5]. Here, we describe a rare case involving the migration of an appropriately placed indwelling CVC.…”

Migration of jugular or subclavian venous catheters into inferior tributaries of the brachiocephalic veins or into the azygos vein, with possible complications

“…More than 20 patients have been reported in whom a central venous catheter (almost always from the left subclavian or a left jugular vein), as seen on frontal roentgenograms, extended across the left BCV and the SVC, to end with the tip appearing to abutt against the lateral wall of this vessel almost at a right angle [10,14,[42][43][44][45][46][47][48][49]. All these patients developed hydrothorax and/or mediastinal widening, reportedly from extravasation of the infusate, with complete clearing of the findings after removal of the catheter.…”

Chest tightness and mediastinal widening

“…It is also a rare complication of central venous catheter insertion and tends to occur within 1 week of catheter insertion. 1,2 Patients often present with sudden onset dyspnea or chest pain, and chest radiographs often show mediastinal widening and unilateral or bilateral pleural effusions. 2 Abutment of the catheter tip against a vein wall is often overlooked on chest radiographs used to confirm the catheter placement.…”