Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery

Brachiocephalic Vein Injury Leading to Massive Hemothorax Following the Insertion of a Tunneled Dialysis Catheter Requiring Surgical Intervention for Repair: Report of a Rare Case

Dialysis catheters are commonly used tools for patients requiring hemodialysis. A dilator with a large caliber is used to insert such a catheter, which in turn can result in serious vascular injury leading to rare complications like hemothorax. Common treatment options for such vascular injuries comprise surgical repair by thoracotomy or video-assisted thoracoscopic surgery (VATS) and endovascular repair. We herein report a case of a brachiocephalic vein injury and massive right-sided hemothorax following the insertion of a tunneled dialysis catheter in the right internal jugular vein, treated successfully by our team at Square Hospitals Ltd.

Cardiac perforation due to delayed migration of a chronic dialysis catheter: a case report

Background

Tunnelled haemodialysis catheters are commonly used to perform haemodialysis. Rare complications of these catheters include perforations of major blood vessels or the heart. Albeit rare, these complications can lead to significant morbidity and mortality.

Case summary

We present a case of late migration of a tunnelled haemodialysis catheter causing a right atrial perforation with subsequent pericardial tamponade, haemodynamic shock, and cardiac arrest. A 51-year-old female patient with end-stage renal disease presented with hypotension and lactate acidosis, indicating circulatory shock, during ambulatory intermittent haemodialysis. Dialysis was performed through a tunnelled haemodialysis catheter that had been implanted more than 1 year ago. Upon admission to the hospital, initial diagnostics, including transthoracic echocardiography and computed tomography scan, showed a circumferential pericardial effusion which was not haemodynamically significant and no other pathological findings. After being transferred to the intensive care unit, the patient again showed signs of haemodynamic shock at the start of another dialysis session which deteriorated to cardiac arrest. Ultimately, using multi-modality imaging, migration of the catheter tip through the right atrial wall into the pericardial space was diagnosed. Emergency sternotomy and surgical extraction of the tunnelled haemodialysis catheter were performed and the patient recovered completely.

Discussion

Migration and perforation of a tunnelled haemodialysis catheter can occur late after implantation and lead to circulatory shock, thus requiring immediate diagnostic workup and surgical therapy. Routine diagnostic procedures may be insufficient for making a correct diagnosis. More specific approaches, such as multi-modality imaging including contrast echocardiography, should be implemented upon clinical suspicion.

Treatment of a central venous perforation caused by dialysis intubation using coils and cyanoacrylate glue: A case report

Central venous catheter is one of the most commonly used vascular therapies in patients receiving hemodialysis and vascular perforation is a rare but serious complication. The present study reports on a case of a 64-year-old female who developed massive hemothorax and hemorrhagic shock after long-term dialysis due to central venous perforation during placement of the central venous catheter. This case was successfully managed by digital subtraction angiography-guided direct injection of coils and cyanoacrylate glue into the sinus tract. In addition, the literature regarding central venous perforation resulting from long-term dialysis catheters was reviewed, risk factors and prevention strategies were summarized and the advantages and disadvantages of various therapeutic approaches were compared.

Management of venous perforation during central venous catheterization in hemodialysis patients: Three case reports

RATIONALE

In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage.

PATIENTS CONCERNS

Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis.

DIAGNOSES

Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed.

INTERVENTIONS

In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed.

OUTCOME

In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained.

LESSONS

When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.

Central Venous Catheter Placement in the Left Internal Jugular Vein Complicated by Perforation of the Left Brachiocephalic Vein and Massive Hemothorax: A Case Report

An elderly male presented for emergent repair of a ruptured abdominal aortic aneurysm. For anticipated volume resuscitation, vasopressor administration, and hemodynamic monitoring, a large-bore central venous catheter was placed in the left internal jugular vein under ultrasound guidance before surgical incision. Initially, there were no readily apparent signs of venous perforation. However, a massive left hemothorax developed because of perforation of the brachiocephalic vein and violation of the pleural space. This case report discusses both prevention and management of such a complication.