Pericardial tamponade caused by central venous catheters

Abstract

Three cases of pericardial tamponade caused by central venous catheters are reported. Two essential factors have been recognized. First, the catheter material should be extremely soft and remain soft. Today the best material available seems to be a silicone rubber elastomer. Polyvinylchloride or polyethylene, which is widely used, is too rigid. These materials also contain phthalate esters to soften the plastic, and these softeners are gradually washed out into the bloodstream, rendering the catheters even more rigid in time. Second, a central venous catheter should enter the venous system proximal to the shoulder. When the catheter is inserted through a vein in the arm, the tip of the catheter will be able to progress 6-10 cm farther down in the venous system by extreme movements of the arm. This occurs regularly when a patient is turned in bed and his or her arm is elevated 108 ~ at the shoulder. The internal jugular vein and the subclavian vein are the most suitable veins for catheterization. Veins in the arm should not be used.

Central Venous Catheters: Do we need to Review Practice on Positioning?

“…Antecubital peripherallyinserted central catheters (PICC) lines can advance up to 7 cm, as shown in a cadaveric study. 8 As catheters are known to move with positioning of the patient, an insufficiently inserted CVC catheter can easily be outside the SVC. This could increase the risk of thrombus formation and vessel wall perforation.…”

Cardiac tamponade complicating central venous catheter

“…)2 No case of myocardial perforation by this type of catheter has been reported. (2) The catheter position should be checked by a chest X-ray immediately after insertion. It should lie no more than 2 cm below a line joining the lower borders of the clavicles.6 Central lines should not be within the cardiac silhouette by chest X-ray.…”

Central venous catheters in acute blood malignancies

“…The placement of the catheter tip at some distance from the right atrium is due to the risk of cardiac perforation. 12 Further discussion may be necessary to determine what kind of introduction technique is preferable. The surgical exposure technique used in this study seems in our opinion to be a safe technique, and we believe that this tech- No.…”