Key result
Subcutaneous implantation of a chemotherapeutic injection port without radiographic monitoring resulted in right ventricular perforation, fatal hydropericardium, and cardiac tamponade in one patient.
Case Report (n=1)
Highlights the critical importance of radiographic monitoring following the placement of central venous implant systems to prevent fatal complications such as right ventricular perforation and cardiac tamponade.
May warrant radiographic confirmation after port placement; leaves open whether routine imaging prevents rare fatal perforations.
The need to obtain dependable access to the vascular system constitutes a significant component in the treatment and management of critically ill patients. Intravenous chemotherapy administered to cancer patients over an extended period of time often results in loss of peripheral vascular access due to vein sclerosis, "exhaustion" or tissue necrosis. Medical investigators have designed and steadily upgraded a variety of devices constructed to improve venous access for long-term utilization. As with the introduction of any foreign object into the body, each of these devices has complications which may be life threatening and occasionally fatal. We present an unusual case of iatrogenic acute hydropericardium and cardiac tamponade caused by the percutaneous infusion of chemotherapeutic fluid via a right subclavian central venous implant system (Port-a-Cath). Failure to implant and monitor the device with a radiograph following placement according to manufacturer's guidelines and accepted standards of medical practice were causally related to an unusual complication, namely, perforation of the right cardiac ventricle by the catheter tip, resulting in sudden and unexpected cardiac death.
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Hunsaker et al. (2003) conducted a case report in Cancer requiring intravenous chemotherapy (n=1). Subcutaneous implantation of a chemotherapeutic injection port (Port-a-Cath) was evaluated on Iatrogenic acute hydropericardium and cardiac tamponade. Subcutaneous implantation of a chemotherapeutic injection port without radiographic monitoring resulted in right ventricular perforation, fatal hydropericardium, and cardiac tamponade in one patient.
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