An unusual complication during central venous catheter placement

A 31-year-old man with disseminated Coccidioides imitis infection required central catheter placement for access. The patient had an inferior vena cava (IVC) filter placed as a result of previous deep venous thrombosis of the left lower extremity. The guidewire could not be removed following placement of the right internal jugular catheter by the Seldinger technique. Fluoroscopic examination revealed entanglement of the J-tip guidewire in the apex of the IVC filter. The catheter was successfully removed by interventional radiologists using a snare tip catheter through the left femoral vein.     

Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication

Cardiac arrhythmias during central venous catheter (CVC) insertion are typically transient events with no hemodynamic repercussions. Pediatric reports on this condition are scarce and fail to describe potentially life-threatening complications.

Case

A 14-day-old boy was admitted to the pediatric intensive care unit presenting with septic shock. During CVC insertion, the patient developed supraventricular tachycardia (SVT), which was unresponsive to vagal maneuvers or adenosine. Chest roentgenogram control revealed the tip of the catheter positioned in the midportion of the superior vena cava. After 30 minutes, the patient had a heart rate of 215 beats/min (bpm) and signs of hemodynamic compromise. The SVT eventually reverted to a sinus rhythm with synchronized cardioversion. The patient was discharged in good health.

Conclusion

Awareness of this potential complication of CVC insertion warrants a high level of concern by pediatric surgeons performing these procedures. Patients with sepsis and/or cardiac dysfunction who present SVT during catheter insertion can represent a therapeutic challenge for surgeons.     

Arch vessel injury during pulmonary artery catheter placement

We have observed seven instances of unintentional cannulation of major arteries with 8F sheaths during preparation for open-heart operation. When the sheath was removed and the operation delayed, there were no complications; in the two instances in which the open-heart operation was performed immediately after arterial cannulation, there was 1 death due to hemorrhage and 1 false aneurysm of the carotid artery. Elective open-heart operations should be delayed if unintentional cannulation of a major artery occurs.     

Pericardial placement of a pulmonary artery catheter

Extravascular placement of a pulmonary artery catheter occurred when it was passed down an in situ sheath, the side arm of which had already been used for administration of fluids without any problems. The case emphasises that complications occur with the use of invasive monitoring and a correctly placed line may become extravascular even in a short time.     

Diagnosis of a left-sided superior vena cava during placement of a pulmonary artery catheter

We report a case of a left sided superior vena cava (SVC) that was diagnosed during placement of a pulmonary artery (PA) catheter. After entering the left internal jugular, the PA catheter passed into the left side of the heart, through the aortic valve, and into the aorta. This was an unusual cause of right-to-left shunting and persistent cyanosis in a patient who had undergone two open cardiac procedures, including repair of an atrial septal defect. Cardiac catherization and echocardiography also failed to reveal the abnormality.

The embryology and physiology of a left sided SVC is reviewed, including an historical perspective. A discussion of the variants of the syndrome is included, as is a review of aberrant placement of central venous catheters.     

Femoral venous catheter: an unusual complication

We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.     

Inadvertent placement of pulmonary artery catheter into right carotid artery

PURPOSE: To report a case of misplacement of a pulmonary artery catheter (PAC) into the carotid artery after open heart surgery. CLINICAL FEATURES: A 20-mo-old boy underwent open heart surgery (VSD repair). On the first day postoperatively, he had severe pulmonary hypertension and a PAC was inserted via the left internal jugular approach without complication. Two hours later, chest radiography showed the PAC in the right internal carotid artery which it had reached via the right and left ventricles and aorta. The PAC was withdrawn and a new PAC was inserted and its position was confirmed by chest radiography. Two years later echocardiography failed to demonstrate the second VSD or a residual leak through the patch although a PAC could be passed from the right ventricle to the left ventricle and subsequently into the aorta and right carotid artery. CONCLUSION: Correct placement of a PAC should be confirmed by chest radiography or other techniques to prevent complication.     

An unusual case of pulmonary artery catheter malfunction

IMPLICATIONS: Sudden loss of thermodilution or temperature-monitoring capabilities of an indwelling pulmonary artery catheter may indicate significant damage to the catheter, possibly leading to electrical hazard and infection risk. Blood appearing at the electrical connection port confirms the diagnosis. The catheter, if easily removed, should be replaced as soon as possible.     

Cardiac arrest during removal of a pulmonary artery catheter

Purpose

This case report describes an asystolic cardiac arrest that occurred during removal of a pulmonary artery (PA) catheter.

Clinical features

A 70-yr-old man underwent elective hepatectomy because of hepatic carcinoma with a combination of thoracic epidural blockade and general anaesthesia. After the conclusion of the operation, the PA catheter was removed and immediately after, the patient developed profound sinus bradycardia and hypotension followed by asystolic cardiac arrest. Two minutes after the onset of asystole, cardiac rhythm was detected following the administration of epinephrine and atropine. He had no further episodes of bradycardia or neurological deficit.

Conclusion

Removal of a PA cathether has the potential of inducing asystole requiring cardiac resuscitation and availability of emergency drugs.