A patient with an uncommon complication from insertion of a central venous catheter: A case report
© Khalid et al; licensee BioMed Central Ltd. 2008
Received: 15 September 2008
Accepted: 26 November 2008
Published: 26 November 2008
A 72 year old male was admitted to the medical intensive care unit with septic shock.
A left subclavian central venous catheter was inserted on the day of admission whose tip was pushing against the wall of the vessel lumen. The patient's condition improved with treatment, but three days later had a new episode of acute hypotension. CT scan of the chest showed that the catheter had eroded through the superior vena cava wall.
The catheter was pulled out and patient recovered from the complication with supportive therapy. Care should be taken that the tip of the catheter is in the center of the vessel lumen to avoid this rare, but potentially life threatening, complication.
Central venous catheters are placed in patients every day in intensive care units, more than 5 million every year just in the United States alone. Infection is the common complication associated with the central venous catheters, and subclavian vein route having the least incidence as compared to femoral or internal jugular routes. The rate of mechanical complications is about 14% which includes failure to place the catheter, arterial puncture, improper position, pneumothorax, hematoma, hemothorax, and asystolic cardiac arrest of unknown etiology. Arrythmias and venous air embolism can also occur.[4, 5] We report here an uncommon complication associated with the insertion of central venous catheters.
The non-traumatic perforation of superior vena cava by central venous catheter tip is relatively rare and has been reported in the catheters inserted via a subclavian approach.
Even though the incidence of the complication is low, nonetheless, care should be taken that the tip of the catheter is in the center of the vessel lumen and is not pushing against the wall to avoid such a complication.
Written informed consent was obtained from the patient's next of kin for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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