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[Perforation of the superior vena cava due to unrecognized stenosis. Case report of a lethal complication of central venous catheterization].
Anaesthesist 2001; 50(10):772-7A

Abstract

We report on a case of fatal perforation of the superior vena cava. The perforation occurred after catheterization of the left internal jugular vein with a hemodialysis catheter, due to an unrecognised stenosis of the superior vena cava. Vascular trauma induced by a previous, also left-sided, subclavian vein-hemodialysis catheter (in place for 14 days), seemed to be the most likely pathomechanism of the stenotic lesion. It should be emphasised that this is a frequent complication especially of left-sided dialysis catheters. In the case described a stenosis was complicated by a misdirected second hemodialysis catheter. Although being repositioned under fluoroscopic control via a guide wire, an extravasal placement occurred but was unrecognised. In order to rule out catheter misplacement, the position of every central venous catheter has to be controlled. Standard methods are either chest X-ray or right atrial electrocardiography. Additionally, confirmation of correct intravenous placement requires a combination of free venous backflow of all lumen and/or blood gas analysis or venous pressure monitoring. Only a combination of tests gives ample certainty as each test for itself has its pitfalls. After placement of hemodialysis catheters, in particular left-sided catheters, we demand chest X-ray in order to verify that the catheter runs parallel with the long axis of the superior vena cava. In doubtful cases the threshold for contrast-enhanced angiographic control of the catheter should be low. If a perforation by the catheter is suspected it should be ruled out by computed tomographic scanning or transesophageal echocardiography.

Authors+Show Affiliations

Klinik für Neurologie, Universitätsklinikum Eppendorf, Hamburg. i8scwo@rz.uni-jena.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

ger

PubMed ID

11702327

Citation

Schummer, W, et al. "[Perforation of the Superior Vena Cava Due to Unrecognized Stenosis. Case Report of a Lethal Complication of Central Venous Catheterization]." Der Anaesthesist, vol. 50, no. 10, 2001, pp. 772-7.
Schummer W, Schummer C, Fritz H. [Perforation of the superior vena cava due to unrecognized stenosis. Case report of a lethal complication of central venous catheterization]. Anaesthesist. 2001;50(10):772-7.
Schummer, W., Schummer, C., & Fritz, H. (2001). [Perforation of the superior vena cava due to unrecognized stenosis. Case report of a lethal complication of central venous catheterization]. Der Anaesthesist, 50(10), pp. 772-7.
Schummer W, Schummer C, Fritz H. [Perforation of the Superior Vena Cava Due to Unrecognized Stenosis. Case Report of a Lethal Complication of Central Venous Catheterization]. Anaesthesist. 2001;50(10):772-7. PubMed PMID: 11702327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Perforation of the superior vena cava due to unrecognized stenosis. Case report of a lethal complication of central venous catheterization]. AU - Schummer,W, AU - Schummer,C, AU - Fritz,H, PY - 2001/11/13/pubmed PY - 2002/1/5/medline PY - 2001/11/13/entrez SP - 772 EP - 7 JF - Der Anaesthesist JO - Anaesthesist VL - 50 IS - 10 N2 - We report on a case of fatal perforation of the superior vena cava. The perforation occurred after catheterization of the left internal jugular vein with a hemodialysis catheter, due to an unrecognised stenosis of the superior vena cava. Vascular trauma induced by a previous, also left-sided, subclavian vein-hemodialysis catheter (in place for 14 days), seemed to be the most likely pathomechanism of the stenotic lesion. It should be emphasised that this is a frequent complication especially of left-sided dialysis catheters. In the case described a stenosis was complicated by a misdirected second hemodialysis catheter. Although being repositioned under fluoroscopic control via a guide wire, an extravasal placement occurred but was unrecognised. In order to rule out catheter misplacement, the position of every central venous catheter has to be controlled. Standard methods are either chest X-ray or right atrial electrocardiography. Additionally, confirmation of correct intravenous placement requires a combination of free venous backflow of all lumen and/or blood gas analysis or venous pressure monitoring. Only a combination of tests gives ample certainty as each test for itself has its pitfalls. After placement of hemodialysis catheters, in particular left-sided catheters, we demand chest X-ray in order to verify that the catheter runs parallel with the long axis of the superior vena cava. In doubtful cases the threshold for contrast-enhanced angiographic control of the catheter should be low. If a perforation by the catheter is suspected it should be ruled out by computed tomographic scanning or transesophageal echocardiography. SN - 0003-2417 UR - https://www.unboundmedicine.com/medline/citation/11702327/[Perforation_of_the_superior_vena_cava_due_to_unrecognized_stenosis__Case_report_of_a_lethal_complication_of_central_venous_catheterization]_ DB - PRIME DP - Unbound Medicine ER -