Iatrogenic cardiac tamponade after central venous catheter

Abstract

Summary:Myocardial perforations with a central venous catheter are m in adults (67 cases published since 1968). These accidents are fatal in more than two-thirds of the cases owing to confusion caused by misleading symptoms which suggest pulmonary embolism. The perforation is generally localized in the right atrium (29 cases), less frequently in the right ventricle (1 8 cases). The superior vena cava is rarely affected (3 cases). The site of the perforation was not found in the other published cases. Clinical symptoms are signs of tamponade with disorders of cardiac hythm. An enlargement of the cardiac shadow and an abnormal position of the catheter, buckled or openly intrapericardial, make the diagnosis radiologically.Echocardiography provides some information, but this is often too late for practical application. The diagnosis is made with right catheterization when it shows an equalization of the diastolic pressures. This allows the patient to be watched closely following the pericardial tap, after which a surgical approach may be indicated and perfonned. Prevention of these iatrogenic accidents must be systematic and strictly controlled for.

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

“…It is impossible to overemphasize the importance of an adequate positioning of SVC cannulae for preventing complications, including cardiac perforation, an obscured surgical field, venous air lock in the bypass circuit, and microemboli, all of which can be caused by an inadequately positioned SVC cannula [1–6]. Particularly during minimally invasive cardiac surgery, the inherent characteristics of the percutaneous catheter, such as a longer length and smaller internal diameter compared with standard cardiopulmonary bypass cannulae, reduce venous drainage efficiency during bypass surgery [11].…”

“…To reduce the surgical incision size in minimally invasive cardiac surgery, percutaneous insertion of superior vena cava (SVC) cannulae via the internal jugular vein is necessary for venous drainage during cardiopulmonary bypass. SVC cannulae must be placed at an adequate depth, because a SVC cannula that is too deep increases the risk of cardiac perforation, impedes surgical field, and causes venous air lock in the bypass circuit [1–4], whereas a SVC cannula that is too shallow increases the risk of microemboli and blood trauma [5, 6]. Transesophageal echocardiography has been reported to be useful at the time of cannula insertion to ensure the adequate positioning of SVC cannulae [4].…”

Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery

“…3,9 This high mortality rate is often linked to delayed recognition with 53% of diagnoses made during postmortem examination. 10 The most frequent sites of perforation include the right atrium, right ventricle, and SVC, which have incidence rates of 43%, 27%, and 4%, respectively. 10 Malposition of a central venous catheter has been documented as a major risk factor for cardiac and vessel wall perforation.…”

“…10 The most frequent sites of perforation include the right atrium, right ventricle, and SVC, which have incidence rates of 43%, 27%, and 4%, respectively. 10 Malposition of a central venous catheter has been documented as a major risk factor for cardiac and vessel wall perforation. 3 Thus, the current recommendation for the insertion of a central venous catheter via the subclavian or jugular veins is 20 cm for the left side and 16 cm for the right side in the majority of adult patients.…”

Massive haemothorax from central venous catheterization: a note of caution.

“…When vascular erosion occurs, the catheter tip does not usually cause a large perforation in the vascular wall. In fact, the exact site at times cannot even be identified at autopsy (Chabanier et al, 1988). Therefore, haemorrhage is generally slight, and the fluid found on thoracocentesis is bloody only rarely.…”