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Cardiac tamponade from misplaced central venous line in pericardiophrenic vein
T W van Haeften1, E C van Pampus, H Boot
1Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands.
Insights
Internal jugular vein catheterization carries a risk of malposition, potentially leading to cardiac tamponade. Preventive measures include careful technique and imaging to avoid serious complications.
Area of Science:
- Cardiology
- Medical Devices
- Patient Safety
Background:
- Central venous catheterization is a common procedure.
- Internal jugular vein catheterization is frequently performed for central venous access.
Observation:
- A rare case of left internal jugular vein catheter malposition is presented.
- The catheter migrated to the left pericardiophrenic vein and perforated the pericardium, causing cardiac tamponade.
- Three similar incidents occurred at the institution, suggesting this malposition may be underreported.
Findings:
- Catheter malposition can lead to life-threatening complications such as cardiac tamponade.
- Preventive strategies are crucial to minimize the risk of such adverse events.
Implications:
- Implementing strict protocols for internal jugular vein catheterization can enhance patient safety.
- Increased awareness and vigilance are necessary to prevent catheter-related injuries.
Abstract:
A patient in whom a left internal jugular vein catheter had first migrated into the left pericardiophrenic vein, and subsequently had perforated into the pericardium leading to a cardiac tamponade is described. Although this malposition has rarely been reported, it does not seem to be so infrequent, as three other similar misplacements have occurred in our institution. This malposition can be prevented by a high degree of suspicion, preferential use of the right internal jugular vein for catheterization, routine use of a J-tipped guidewire, limiting the depth of insertion of the guidewire during cannulation, routine roentgenographic control of radiopaque catheters, and (slow) injection of a small volume of radiopaque dye through the central venous catheter.