Interluminal Connection in a Failed Central Venous Line

To the Editor: Central venous lines are used in the current medical practice for both hemodynamic monitoring [1] and for venous access. The complication rates [2-5] with these catheters and techniques are relatively low. We present a rare complication with one of these catheters. In our intensive care unit, a four-lumen 8.5F catheter was placed under sterile settings with no technical problems. We realized that, as we injected a total parenteral nutrition solution, it was refluxing back from another lumen. The superior vena cava was patent, and the venous pressures [6] were not increased. We concluded that there was a communication between the two lumens. After removal of the catheter, there was no apparent fracture or bending of the catheter; a contrasted film of the catheter showed a communication between the two lumens. The catheter was sent to the manufacturing company for further investigation and analysis, which supported our diagnosis of interluminal connection. So far, this kind of mechanical failure has not been reported. (Figure 1) Although, in our case, the failure of the catheter was not clinically significant, clinicians should be aware of the possible adverse effects of such a communication possibly resulting in false pressure readings or drug administrations.Figure 1: Contrasted x-ray of the central venous line with the communicating part, which shows an increased amount of contrast pooling.A.