title: Ventricular perforation associated with central venous introducer-dilator systems.
abstract: OBJECTIVE
  Cardiac perforation is a recognised complication of guidewire-introducer techniques. These two new cases of right ventricular perforation implicate the dilator-introducer: one directly and the other due to presumed guidewire buckling.
  
  
  METHODS
  An 85-yr-old man underwent right subclavian cannulation for triple-lumen and pulmonary artery (PA) catheter insertion before coronary artery surgery. Tachycardia (120 bpm) and hypotension (60/30 mmHg) evolved over the next 40 min and resolved with evacuation of 200 ml of clot from the pericardial sac. A ragged 4 mm laceration of the ventricular wall was localised and oversewn without further consequence. A 60-yr-old man with inferior vena caval thrombosis was scheduled for Greenfield filter insertion. The right internal jugular vein was cannulated using the guidewire-introducer technique. Introduction of the introducer-dilator system precipitated cardiovascular collapse. Resuscitation was unsuccessful and post-mortem revealed right ventricular perforation and pericardial tamponade.
  
  
  CONCLUSIONS
  These cases suggest that shorter introducer-dilators would be safer and probably equally efficacious. The need for a high index of suspicion and rapid therapeutic intervention is also highlighted.
authors.affiliation: Department of Anaesthesia, Intensive Care and Cardiac Surgery, Mater Hospital, Dublin, Ireland.
authors.forename: J M
authors.initials: JM
authors.lastname: Porter
authors.forename: R
authors.initials: R
authors.lastname: Page
authors.forename: A E
authors.initials: AE
authors.lastname: Wood
authors.forename: D
authors.initials: D
authors.lastname: Phelan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006335:Heart Injuries / Q000209:etiology*; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged