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Fatal cardiac tamponade. Occurrence with other complications after left internal jugular vein catheterization
Insights
Central venous catheterization, particularly via the left internal jugular vein, can cause fatal cardiac tamponade. Avoiding this approach and using flexible catheters can reduce serious complications.
Area of Science:
- Cardiology
- Vascular Surgery
- Critical Care Medicine
Background:
- Central venous catheterization is a common procedure for hemodynamic monitoring and fluid/medication administration.
- The internal jugular vein is a frequent site for central venous access, with the left-sided approach sometimes preferred.
Observation:
- A case of fatal cardiac tamponade occurred due to superior vena cava perforation during left internal jugular vein catheterization.
- Two nonfatal cases of combined hydromediastinum and hydrothorax resulted from the left-sided approach.
Findings:
- Unexplained hypotension with venous distention in patients with central venous catheters may indicate cardiac tamponade.
- The left internal jugular vein approach is associated with specific risks of perforation and fluid collection.
Implications:
- Avoiding the left internal jugular vein approach may reduce the incidence of these severe complications.
- Utilizing flexible catheter materials and ensuring proper catheter tip placement above the pericardial reflection are crucial safety measures.
Abstract:
A case of fatal cardiac tamponade caused by superior vena cava perforation complicating left internal jugular vein catheterization and infusion is reported. Two cases of nonfatal combined hydromediastinum and hydrothorax as a result of the left-sided approach are discussed. Unexplained hypotension with venous distention in a patient with a central venous catheter should immediately raise the possibility of cardiac tamponade. Avoidance of the left internal jugular vein approach, the use of flexible catheter materials, and localization of the catheter tip above the pericardial reflection will lessen the complications caused by placement of central venous lines.