Inadvertent transpericardial insertion of a central venous line with cardiac tamponade failure of preventive practices

Losert, Heidrun; Prokesch, Rupert; Grabenwöger, Martin; Waltl, Barbara; Apsner, Robert; Sunder‐Plassmann, Gere; Muhm, Manfred

doi:10.1007/s001340051331

Cited by 17 publications

(21 citation statements)

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“…Although chest radiography cannot rule out the development of complications from catheter tip malposition (4), it should always be performed at the time of insertion to confirm the position (3, 5). Several guidelines have been formulated for proper CVC placement with radiological monitoring, however, none can guarantee an absence of risk.…”

Section: Discussionmentioning

confidence: 99%

“…However, such references are not valid for a supine patient on the operating table. In an attempt to resolve this, another anatomical landmark at the junction of the right main bronchus and the trachea, which represents the upper limit of the pericardial reflection over the lowest portion of the superior vena cava has been suggested (4). Some authors (3, 11) place the landmark at the third costosternal junction, the T5 level (T2 for neonates) (3), or at 2 cm from the pericardial reflection (11).…”

Section: Discussionmentioning

confidence: 99%

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Cardiac tamponade associated with a peripheral vein central venous catheter

Godet¹,

Pellisé

González-P³

et al. 2005

Pediatric Anesthesia

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SummaryWe present a case of cardiac tamponade associated with placement of a central venous catheter (CVC) via a peripheral vein in a 14-year-old girl with idiopathic scoliosis undergoing corrective surgery. A number of complications have been described in association with CVC misplacement. Sporadic cases of cardiac tamponade from this have been reported, but the actual incidence is unknown. Death from cardiac tamponade attributed to CVCs ranges from 65 to 100%. In our patient, cannulation of the pericardiophrenic vein was probably the cause of cardiac tamponade, based on radiological evidence that the initial location of the catheter was near the right atrium and possibly at the outlet of the pericardiophrenic vein. The catheter could have advanced into the vein and then to the pericardial sac with postural changes. The acute clinical course of cardiac tamponade in our patient had potentially lethal hemodynamic repercussions. The main diagnostic test for this condition is echocardiography and the only effective treatment is drainage of the pericardial effusion. Echocardiography should be performed before pericardiocentesis except in life-threatening situations or high clinical suspicion. Although they are rare, it is important to be aware of the potential for CVC complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac tamponade associated with a peripheral vein central venous catheter

Godet¹,

Pellisé

González-P³

et al. 2005

Pediatric Anesthesia

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“…Zentralvenöse Katheter außerhalb der zentralvenösen Zirkulation -also in kleineren Venen -können durch Perforation eher lebensbedrohliche Komplikationen, wie Hydrothorax, Hydromediastinum [4] und Perikardtamponade verursachen [13,23]. Des Weiteren können in solche Venen applizierte hyperosmolare Lö-sungen (z.…”

Section: Diskussionunclassified

“…Alle genannten Kontrollmaßnahmen geben für sich allein jedoch keine völlige Sicherheit [4,13,14,22]. Bei geringstem Zweifel sollte zum Ausschluss einer Gefäßperforation wasserlösliches Kontrastmittel über den Katheter injiziert werden [22,26,27].…”

Section: Lagekontrolle Zentralvenöser Katheterunclassified

Differenzialdiagnose linksthorakaler Venenkatheter am Beispiel einer persistierenden linken oberen Hohlvene

Schummer¹,

Schummer²,

Reinhold³

2002

Anaesthesist

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The differential diagnosis of left-sided thoracic central venous catheters is discussed in context with the cannulation of a persistent left superior vena cava. In this case the catheter tip was seen lying to the left of the spine on frontal chest X-ray. In addition to the descending aorta, differential diagnoses are a persistent left-sided superior vena cava as well as other smaller veins such as the left internal thoracic vein, the left superior intercostal vein, or the pericardiophrenic vein. The misplacement of a venous catheter in a pericardiophrenic vein may result in a fatal pericardial tamponade.

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“…After successful insertion there is an on‐going risk of infection, occlusion, and thrombosis 1 . A rare yet commonly fatal complication is cardiac tamponade, which carries a mortality of 65−78% 1,2 . Fluoroscopy to confirm the position of guidewire prior to dilation and placement of the catheter, and again to confirm the final position of the catheter, is recommended.…”

mentioning

confidence: 99%