Entrapped central venous catheter

Editor—The case presented by Dhanani and colleagues¹ formedan interesting and informative read. I commend the authors onthe careful way in which they handled the situation. However,a couple of points struck me:

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Malposition of central venous catheter

Key words  central venous catheter - malposition     

The entrapped central venous catheter

The central venous catheter (CVC) is associated with numerouscomplications more so during the process of insertion. We reportfor the first time how an indwelling catheter was entrappedby a replacement catheter on the same side, after being spearedby the introducer needle and guidewire. The diagnosis was madewhen there was difficulty in removing the old catheter. Subsequently,interventional radiology services were used to define the problemand help in removal of the entrapped catheter. The mechanismof entrapment and the actual procedure used for removal of thecatheter is described. The dangers of insertion of a CVC onthe same side as a pre-existing one are highlighted.     

Modified central venous catheter for pneumothorax

Pneumothorax frequently requires drainage, and many thoracic surgeons continue to use the traditional rigid chest tubes. Traditional tube thoracostomy using a large-bore tube is an essential technique for thoracic surgeons, but it is associated with significant pain at the time of insertion and during continued drainage. We have found a new small-bore, flexible thoracostomy method using a modified central venous catheter that is simple, less painful, and safe.     

Cardiac tamponade and central venous catheter

Two patients survived after emergency surgery for cardiac tamponade which was caused by a central venous catheter perforating the right atrium and the right ventricle. A review of the literature shows 19 reported cases with only two survivals. The possible causes and guidelines for safer use of central venous catheters are discussed.     

Anaphylaxis to benzalkonium chloride-coated central venous catheter

Benzalkonium chloride (BAC) is commonly used as a bactericidal preservative and it may cause allergic reactions in some patients. An unusual case of anaphylactic shock in a 55-year-old woman following insertion of a central venous catheter (CVC) that was coated with BAC is presented. Assuming anaphylactic shock from the CVC, the catheter was removed immediately. Standard resuscitation was started with 100% oxygen, epinephrine, and saline infusion. The patient recovered without any sequelae. One month later, an intradermal skin test was positive for BAC.     

Unusual positioning of a central venous catheter

Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.     

Endotracheal migration of a central venous catheter

Subcutaneous infusion ports for prolonged central venous access are commonly used for drug administration and parenteral nutrition in a wide range of chronic diseases. The extensive use of these devices has to be balanced against its complications, some of which potentially life-threatening. We describe the case of a patient admitted to our unit with haemoptysis and cough. At bronchoscopy the tip of the central venous catheter was discovered protruding into the tracheal lumen. The catheter was pulled out from the subcutaneous pouch under simultaneous surgical control of the tracheal fistula orifice.