Delayed hydrothorax following percutaneous central venous cannulation

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Critical Care Medicine

Background:

• Prolonged use of percutaneous central venous lines is associated with delayed complications.
• Hydrothorax, a rare complication, has been reported following central venous cannulation.

Purpose of the Study:

• To report four cases of delayed hydrothorax after central venous cannulation.
• To investigate the potential causes and suggest preventive measures for this complication.

Main Methods:

• Case series of four adult patients who developed hydrothorax.
• Review of patient data, including catheter placement technique (Seldinger), catheter type, and post-procedure monitoring.
• Analysis of factors contributing to vein wall perforation.

Main Results:

• Four patients developed hydrothorax 1-7 days post-central venous cannulation.
• Catheter tip perforation of an intrathoracic vein wall was identified as the cause.
• Contributing factors included insecure catheter fixation, patient motion, and catheter trajectory in the left jugular system.

Conclusions:

• Delayed hydrothorax can result from gradual vein wall penetration by the catheter tip.
• Minimizing risk involves using soft, pliable catheters, ensuring secure fixation, and considering right-sided line placement due to anatomical advantages.