Late atrial perforation from tunnelled haemodialysis catheter

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

“…This is an extremely rare complication with only 2 published cases in the literature. 6,7 The sudden change in mental status of our patient was presumably caused by a cerebral air embolism from HD. Deciding which method to use to remove the catheter was challenging because of the anomalous course the HD catheter took before terminating in the left atrium.…”

“…If the thrombus had become free-floating while the catheter was being removed, thromboembolism could have led to ischemic injury and devastating outcomes. 6,12 The anesthetic management of our patient was challenging. Routinely practiced precautions were taken when placing the left internal jugular introducer in view of the unknown pathway of the existing line.…”

“…[6][7][8] The incidence varies from 0.25% to 1.4%, and the mortality rate can be as high as 85%. 3,9 This high mortality rate is often linked to delayed recognition with 53% of diagnoses made during postmortem examination.…”

“…1,3 Other important factors include the type and size of the catheter, the angle of the catheter relative to the vessel wall, the osmolarity of the fluid being infused, and anatomical variations. 1,3,6 Mechanisms postulated to contribute to perforations include erosion of the myocardial wall from catheter malposition, catheter migration, and direct trauma during CVC. 3,11 Failure to consider cardiac and vascular wall perforations as differentials in cases of sudden clinical deterioration could lead to serious clinical sequelae, including death.…”

“…3,5,6 A misplaced central venous catheter can erode and perforate the heart and vessel walls, resulting in blood extravasation and immediate hemodynamic collapse. 1,3 A high index of suspicion must be maintained and telltale signs must be recognized for prompt detection of potentially fatal complications.…”