Videothoracoscopic-guided management of a central vein perforation during hemodialysis catheter placement

Abstract

We present a case of the successful repair of an iatrogenic central vein lesion using a videothoracoscopic approach. The confluence of the right innominate vein and the superior vena cava was perforated during the placement of a right internal jugular vein long-term dialysis catheter. The misplacement of the tips of the catheter in the right pleural space was promptly observed. The catheter was removed under pleural videothoracoscopic vision while a tamponade was directly applied to the mediastinal perforation. Massive bleeding was prevented and the central vein perforation was treated successfully using a minimally invasive technique.

Central vein perforation during tunneled dialysis catheter insertion: Principles of acute management

“…In addition, CT facilitates endovascular repair by delineating the vascular anatomy and vessel caliber, allowing pre‐procedural sizing of the necessary devices such as stent grafts and balloons. Whenever possible, the catheter should only be removed during surgery or endovascular repair after achieving access and control at the site of the perforation, as demonstrated in our case …”

Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report

“…However, in cases such as the one presented here, if vital signs are stable and no coagulopathy is present, a less-invasive thoracoscopy could be considered to assess the situation and correct the problem. Few reports of the benefits of thoracoscopic management of central venous injury are available [11,12]. However, as Kuzniec et al [12] reported, there is no possibility of direct compression except by invasive thoracotomy, when there is an iatrogenic central vein perforation to the pleural space.…”

“…Few reports of the benefits of thoracoscopic management of central venous injury are available [11,12]. However, as Kuzniec et al [12] reported, there is no possibility of direct compression except by invasive thoracotomy, when there is an iatrogenic central vein perforation to the pleural space. If the catheter acts a plug for the perforated site for a relatively long period, withdrawal of a large-bore catheter without direct compression can lead to depacking of the injury and possibly to uncontrolled bleeding.…”

Bedside Procedure: Retained Central Venous Catheter

“…It occurs in the acute setting from puncture or perforation into regions of large potential space including the thoracic, abdominal, and retroperitoneal cavities [5,28,35,36]. Unlike the mediastinum or neck which has relatively limited space, these cavities can accommodate a large amount of blood without clinical signs until hemodynamic instability is reached.…”

“…In this case, the catheter is partially occluding the tract and removal of the catheter blindly can lead to increased hemorrhage and death. If circumstances allow, imaging studies to define the path of the catheter are obtained to aid in planning for its safe removal [5,25,36].…”