Chest
Volume 101, Issue 6, June 1992, Pages 1633-1638
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Clinical Investigations in Critical Care
Vascular Erosion by Central Venous Catheters: Clinical Features and Outcome

https://doi.org/10.1378/chest.101.6.1633Get rights and content

We evaluated the clinical characteristics of eight patients who presented with vascular erosion from central venous catheters and reviewed the available literature. Patients typically presented with dyspnea or chest pain, unilateral or bilateral pleural effusions, and mediastinal widening one to seven days after catheter insertion. Pleural fluid appeared transudative with variable glucose concentrations (range, 174 to 588 mg/dl) that were always greater than concurrent serum values. Diagnosis was delayed 3.0 ± 1.5 days (range, 0 to 11 days) after vascular erosion. One patient died and four patients received chest tubes. Seven of eight patients had left-sided line placement; six of these seven left-sided catheters abutted the superior vena cava wall within approximately 45° of perpendicular. Results of a literature search confirm the hazards of delayed diagnosis and the importance of left-sided catheter placement as a risk factor for vascular erosion.

Section snippets

Methods

St. Joseph's Hospital and Medical Center (Phoenix) is a 626-bed teaching hospital that has 61 adult critical care beds. During an 18-month period spanning 1990 to 1991, patients with vascular erosion by central venous catheters were identified by evaluating medical records coded with pleural effusion as a hospital discharge diagnosis and canvassing attending physicians. Patients were included into the study if a pleural effusion first appeared or progressed after placement of a central venous

Results

Eight patients with central catheter erosion resulting in hydrothorax were found by review of medical records. Catheter insertion in these patients represented 0.5 percent of all central lines delivered to adult patient care areas during the study period. The patients’ epidemiologic data, route of catheterization, and fluid infusions are listed in Table 1. All catheters were made of polyurethane and placed with a Seldinger technique. Four patients had double-lumen catheters, one patient had a

Discussion

Despite the advent of pliable central venous catheters with tapered tips, the eight patients with hydrothoraces in this study and the persistently recurrent nature of case reports during the last two decades indicate that catheter erosion remains an important clinical problem. The incidence of this complication appears to be approximately 0.4 percent to 1.0 percent of catheter placements as observed in our experience and that of others.29 The true incidence may be considerably higher, however,

ACKNOWLEDGMENTS

The authors thank Cynthia Rockow for excellent secretarial assistance and Kay Wellik for library services.

References (44)

  • A Okada et al.

    Pleural effusion with intimal injury of superior vena cava caused by central venous catheter: report of a case

    Toku J Exp Med

    (1987)
  • JE Carvell et al.

    Bilateral hydrothorax following internal jugular catheterization

    Br J Surg

    (1976)
  • DD Oakes et al.

    Malposition of a subclavian line

    JAMA

    (1975)
  • S Holt et al.

    Haemothorax after subclavian vein cannulation

    Thorax

    (1977)
  • C Rayner et al.

    Respiratory distress during total parenteral nutrition

    Br J Clin Pract

    (1989)
  • TW Wehmann et al.

    Delayed hydromediastinum after multilumen central venous catheterization

    J Am Osteopath Assoc

    (1988)
  • CB Kapadia et al.

    Delayed recognition of vascular complications caused by central venous catheters

    J Clin Monit

    (1988)
  • CE Aulenbacher

    Hydrothorax from subclavian vein catherization

    JAMA

    (1970)
  • BR Barton et al.

    Cardiothoracic emergencies associated with subclavian hemodialysis catheters

    JAMA

    (1983)
  • JJ Reilly et al.

    Delayed perforation of the innominate vein during hyperalimentation

    Arch Surg

    (1977)
  • CJ Rudge et al.

    Hydrothorax after central venous catheterization

    BMJ

    (1973)
  • JA Usselman et al.

    Superior caval catheter displacement causing bilateral pleural effusions

    AJR

    (1979)
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    Manuscript received September 23; revision accepted December 16.

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