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Cardiac tamponade from central venous catheters
P E Collier1, S H Blocker, D M Graff
1Department of Surgery, Sewickley Valley Hospital, Pennsylvania, USA.
American Journal of Surgery
|September 16, 1998
Summary
Cardiac tamponade from central venous catheters is preventable. Ensuring the catheter tip is outside the cardiac silhouette on chest X-rays can avert this lethal complication. Prompt echocardiograms are crucial for diagnosis.
Area of Science:
- Cardiology
- Medical Devices
- Patient Safety
Background:
- Cardiac tamponade (CT) is a potential lethal complication following central venous catheter (CVC) placement.
- The mechanism of CT and physician awareness of this risk require investigation.
Purpose of the Study:
- Determine the mechanism of CT after CVC insertion.
- Assess physician awareness of CT as a CVC complication.
Main Methods:
- Retrospective review of 25 unreported CT cases associated with CVC.
- Analysis of chest radiographs and postmortem records.
- Survey of 200 physicians regarding their knowledge of CT from CVC and FDA educational materials.
Main Results:
- All reviewed chest radiographs showed CVC tips within the pericardial silhouette.
- Patients presented with unexplained hypotension, chest tightness, shortness of breath, or air hunger post-CVC placement.
- None of the surveyed physicians had viewed the FDA educational video on CVC complications.
Conclusions:
- CT following CVC placement is preventable by ensuring the catheter tip is outside the cardiac silhouette.
- Patients with CVCs developing unexplained hypotension or cardiorespiratory symptoms require urgent echocardiography to rule out CT.