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Management of venous perforation during central venous catheterization in hemodialysis patients: Three case reports
Li-Yun Xu1, De-Jun Chen, Sha-Sha Wang
1Department of Nephrology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang Province, China.
Insights
Early detection and management of central venous catheterization (CVC) complications, like venous perforation, are crucial for hemodialysis patients. Digital subtraction angiography (DSA) offers a safer approach for catheter adjustment or withdrawal.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Central venous catheterization (CVC) is a common procedure for hemodialysis patients.
- Venous perforation is a potential complication of CVC.
- Early detection and management are key to patient outcomes.
Observation:
- Three cases of venous perforation during CVC in hemodialysis patients are presented.
- Computed tomography and X-ray imaging were used for diagnosis.
- Management strategies included catheter repositioning, withdrawal, and monitoring for false lumen formation.
Findings:
- Catheter adjustment under digital subtraction angiography (DSA) guidance after false lumen formation was successful in two patients.
- Immediate catheter withdrawal in one patient led to hemothorax requiring drainage.
- DSA guidance appears to be a reliable method for managing CVC-related venous perforations.
Implications:
- This study highlights the importance of timely diagnosis and tailored management of venous perforation.
- DSA guidance offers a safer and more effective strategy for CVC management in cases of perforation.
- Improved understanding of CVC complications can enhance patient care in nephrology and interventional radiology settings.
Rationale:
In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage.
Patients Concerns:
Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis.
Diagnoses:
Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed.
Interventions:
In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed.
Outcome:
In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained.
Lessons:
When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.
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