Delayed vascular injury and severe respiratory distress as a rare complication of a central venous catheter and total parenteral nutrition

Acute Mediastinitis Due to Extravasation of Parenteral Nutritional Formula via a Central Venous Catheter

“…1 In our case, the sudden onset of respiratory insufficiency 6 days after placement of a CVC, the lack of fever, and the negative results of cultures suggest, as in other reported cases, that leakage of parenteral nutritional formula from the CVC migrated into the mediastinum, causing chemical mediastinitis. 4 The lack of blood in the pleural effusion and the mediastinum, as in our case, has been reported previously. Inaba et al 4 have suggested that the marked phlebitis with transmural edema and thrombus formation prevent extravascular leakage of blood.…”

“…4 The lack of blood in the pleural effusion and the mediastinum, as in our case, has been reported previously. Inaba et al 4 have suggested that the marked phlebitis with transmural edema and thrombus formation prevent extravascular leakage of blood.…”

“…2,3 Nevertheless, the development of vascular erosion after or during CVC placement, a development that may cause mediastinitis, is extremely uncommon; the reported incidence ranges from 0.17% to 0.4%. 4 Only few cases of mediastinitis caused by extravasation of parenteral nutritional formula into the mediastinum through a CVC have been reported. This delayed vascular injury (perforation of a blood vessel by a CVC several days after placement) has 2 suggested mechanisms.…”

“…This delayed vascular injury (perforation of a blood vessel by a CVC several days after placement) has 2 suggested mechanisms. 1,3,4 The first mechanism is mechanical trauma from the catheter tip against the wall of the vessel days after placement. The more perpendicular the catheter tip is to the wall of the vein, the greater is the risk of perforation.…”

“…Synergism of these mechanisms may cause erosion of the vessel wall. 4 Other risk factors for vascular erosion have been reported, including large catheters, older age, and left-sided CVC placement. 4 The time between insertion of the catheter and vascular perforation can be up to 60 days.…”