Cardiac perforation from central venous catheters: survival after cardiac tamponade in an infant

A 2,210-g infant suffered cardiac tamponade, which resulted from atrial perforation by a central venous catheter. The infant survived due to timely diagnostic and therapeutic intervention. Cardiac tamponade should be suspected in any patient with a central venous catheter whose condition deteriorates suddenly. Immediate chest roentgenogram and echocardiogram may be performed to support the diagnosis; but when the patient's condition is deteriorating, a diagnostic (and therapeutic as well!) pericardiocentesis should be performed without waiting for other diagnostic measures. A review of clinical recognition and diagnostic measures for cardiac perforation and tamponade is presented. Preventive measures to avoid this fatal complication of central venous catheters are suggested, and therapeutic interventions are outlined.