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Cardiothoracic emergencies associated with subclavian hemodialysis catheters

B R Barton, G Hermann, R Weil

    JAMA
    |November 18, 1983
    PubMed

    Insights

    Subclavian hemodialysis catheters can cause life-threatening vena cava or right atrium perforations. Proper catheter placement is crucial to prevent these serious complications in patients undergoing hemodialysis.

    Area of Science:

    • Cardiovascular Medicine
    • Nephrology
    • Medical Device Safety

    Background:

    • Subclavian hemodialysis catheters are commonly used for vascular access in patients requiring renal replacement therapy.
    • Potential complications associated with central venous catheterization include infection, thrombosis, and vessel injury.

    Observation:

    • Three adult patients experienced severe, life-threatening perforations of the vena cava or right atrium.
    • These perforations were directly associated with the use of subclavian hemodialysis catheters.

    Findings:

    • Meticulous positioning of the subclavian catheter tip within the superior vena cava lumen is essential.
    • Failure to ensure proper placement, allowing the tip to tent the vena cava wall, increases perforation risk.

    Implications:

    • Clinicians should maintain heightened vigilance for cardiac or vena cava perforation in patients with subclavian hemodialysis catheters.
    • Unexplained, refractory hypotension during hemodialysis in patients with these catheters warrants immediate investigation for perforation.

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