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[Perforation of the cardiac wall during central venous catheterization - muscular defects as a contributing factor
Insights
Central venous catheterization can cause cardiac perforation, even with proper technique. This risk highlights the need for vigilance and imaging to confirm correct catheter placement, especially after repositioning.
Area of Science:
- Cardiology
- Medical Devices
- Patient Safety
Background:
- Central venous catheterization is a common procedure.
- Complications can arise, including rare but serious cardiac perforations.
Observation:
- Two fatal cases of cardiac perforation during central venous catheterization are presented.
- Perforation involved the right ventricle and right atrium.
Findings:
- Even with correct technique and soft catheters, cardiac perforation remains a risk.
- Potential predisposing factors include cardiac muscle weakness (lipomatosis) and atrial wall thinning.
- Catheter entrapment in cardiac structures may also occur.
Implications:
- Radiological confirmation of catheter placement is crucial, particularly after repositioning.
- Enhanced vigilance is necessary to mitigate the risk of cardiac perforation during central venous catheterization.
Abstract:
Two cases of perforation of the cardiac wall during central venous catheterization are reported. One patient, a women, died 6 weeks after perforation of the anterior wall of the right ventricle; the other, also a woman, died immediately following perforation of the posterior wall of the right atrium by a polyethylene catheter. Both cases prove that even a seemingly correct technique and the use of soft catheters cannot entirely exclude the possibility of perforation. Relative weakness of the cardiac muscle due to lipomatosis could have been a pre-disposing factor in one case, and thinning of the atrial wall between the pectinate muscles in the other case. There is also the possibility that the spaces between the trabeculae carneae act as a trap for the catheter. Radiological control of the placement of the catheter should also be performed in those cases where the catheter had to be withdrawn because of malposition in order to make sure of its correct extracardial location.