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Ventricular perforation associated with central venous introducer-dilator systems
1Department of Anaesthesia, Intensive Care and Cardiac Surgery, Mater Hospital, Dublin, Ireland.
Summary
Cardiac perforation during central venous catheterization is a serious risk. Shorter introducer-dilators may reduce the incidence of right ventricular perforation, emphasizing prompt diagnosis and intervention.
Area of Science:
- Cardiology
- Interventional Radiology
- Medical Device Safety
Background:
- Cardiac perforation is a known complication of guidewire-introducer techniques.
- Right ventricular perforation specifically has been linked to dilator-introducer use.
Observation:
- Two cases of right ventricular perforation are presented: one involving direct dilator injury and another suspected guidewire buckling.
- The first case involved a patient undergoing subclavian cannulation for triple-lumen and pulmonary artery catheter insertion, resulting in tamponade that resolved with clot evacuation and surgical repair.
- The second case involved a patient undergoing internal jugular vein cannulation for Greenfield filter insertion, leading to cardiovascular collapse and fatal perforation.
Findings:
- The dilator-introducer system was implicated in both cases of right ventricular perforation.
- Guidewire buckling may contribute to perforation in some instances.
Implications:
- Shorter introducer-dilators may enhance safety and maintain efficacy in central venous catheterization procedures.
- A high index of suspicion for cardiac perforation and rapid therapeutic intervention are crucial for patient management.