Key result
Immediate thoracotomy is required over needle aspiration for cardiac arrest from dialysis catheter right atrial perforation.
Hemopericardium and cardiac arrest resulting from right atrial perforation by a malpositioned dialysis catheter requires immediate thoracotomy, as needle aspiration is ineffective for clotted blood.
Malpositioned subclavian dialysis catheters risk fatal perforation; this Level 5 case leaves open optimal hemopericardium evacuation strategies.
We report a case in which the tip of a malpositioned subclavian dialysis catheter perforated the right atrium and caused a hemopericardium and cardiac arrest. This complication must be immediately recognized and treated, probably by thoracotomy, to ensure survival. Needle aspiration of the pericardium will not remove clotted blood and is unlikely to be of value.
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Hansbrough et al. (2008) studied this question. A malpositioned subclavian dialysis catheter can perforate the right atrium causing hemopericardium and cardiac arrest, requiring immediate thoracotomy rather than needle aspiration.
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