Complications of Central Venous Catheterization

I read with interest the article by Duntley et al,1Duntley P Siever J Korwes ML Harpel K Heffner JE. Vascular erosion by central venous catheters: clinical features and outcome.Chest. 1992; 101: 1633-1638Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar which appeared in the June 1992 issue of Chest. The authors presented clinical data on eight patients with complications caused by central venous catheterization. The authors attributed the respiratory and cardiovascular symptoms observed to vascular erosion and secondary perforation caused by these catheters and offered radiographs to support their hypothesis. I would like to discuss whether another mechanism might be more probable. In at least five of the eight patients, multilumen catheters were inserted. In such patients, extrusion of central lines can be caused by inadequate fixation of the catheters and/or movements of the patients resulting in extravascular positioning of at least one lumen. Pleural effusions and mediastinal widening can also occur by this mechanism. I reviewed 469 of our ICU patients with central lines (218 double- or triple-lumen catheters) and detected 3 secondary dislocations of the multilumen catheters with similar radiographic signs.2Bach A. Dislokation von Mehrlumen-Kathetern: eine potentiell letale Komplikation.Intensivmed. 1992; 29: 184-187Google Scholar In our intensive care patients, diagnosis of outward displacement was confirmed by extravasation of radiographic contrast media infused through proximal ports. Contrast infusion through the distal port demonstrated an adequate intravascular position of the catheter tip in these three patients. The authors did not give detailed information concerning which port was used to infuse the contrast media in their patients. Our findings suggest that the migration of at least one catheter lumen into an extravascular position, not vascular erosion and perforation, could be the cause of the symptoms described in the patients reviewed by Duntley et al. Complications of Central Venous CatheterizationCHESTVol. 104Issue 2PreviewWe appreciate Dr. Bachs suggestion of an additional mechanism for the formation of hydrothoraces in patients with central venous catheters. We do not believe, however, that catheter withdrawal with tissue infiltration of fluid from the proximal port was more probable than catheter-tip erosion through central venous structures in our patient series. All catheters were sutured to the skin to prevent migration, and seven of the eight patients had radiographic evidence of sufficient catheter insertion to avoid positioning of the proximal port within chest-wall tissues. Full-Text PDF