Images in Clinical Medicine
A Complication of Central Venous Catheterization
N Engl J Med 2007; 356:e22May 24, 2007
- Article
A 65-year-old man with a history of hypertension, diabetes mellitus, coronary artery disease with angioplasty and bypass grafting, and deep-vein thrombosis (with placement of an inferior vena cava filter several months earlier) was admitted with heart failure. A right internal jugular catheter was placed for management of congestive heart failure. During placement of the catheter, the guidewire was advanced approximately 50 cm; subsequently, there was difficulty in removing the guidewire, requiring some force to pull it out. A radiograph obtained earlier, confirming the proper placement of a feeding tube, showed that the filter was in the proper position (Panel A). A radiograph obtained after catheter placement showed that the filter was dislodged and in the superior vena cava (Panel B). The dislodged filter was removed through a filter sheath without complication. An inferior venacavogram revealed focal irregularity of the mid-infrarenal inferior vena cava, representing sites where the filter had been attached, but no contrast extravasation was identified. The patient died 2 weeks later from progressive respiratory failure. To avoid this type of complication, advancement of the guidewire should be limited to approximately 10 cm before threading of the catheter.
Sudip Nanda, M.D.
Laurie Strockoz-Scaff, P.A.C.
St. Luke's Hospital, Bethlehem, PA 18015
sudipnanda2000@yahoo.com - Citing Articles (2)
Citing Articles
1
Faisal A. Khasawneh, Roger D. Smalligan. (2011) Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature. Case Reports in Critical Care 2011, 1-4
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Albert Miller. (2009) World Trade Center Multiple Myeloma: Police Responders Only?. Journal of Occupational and Environmental Medicine 51:12, 1357
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