title: The CVC removal distress syndrome: an unappreciated complication of central venous catheter removal.
abstract: The removal of a central venous catheter (CVC) can be complicated by rare but potentially life-threatening neurocardiopulmonary distress. The clinical courses of eight patients who had CVC removal complications are reviewed. Seven patients had catheter removal from the right internal jugular vein, and one from the right subclavian vein. The complications occurred after complete removal of the catheter (four patients), after guidewire replacement for catheter change (three patients), and after detachment of the hemostasis side port of the Swan introducer during sheath removal (one patient). Each of them had more than one complication. The major complications were: neurologic paresis or coma (four patients), respiratory failure (four patients), and shock (two patients). One patient died of pulmonary sepsis. The overall mortality rate was 12.5 per cent. Guidelines for safe removal of central venous catheters are proposed. Possible mechanisms of the complications are discussed. We refer to the observed complications as the CVC removal distress syndrome.
authors.affiliation: Department of Surgery, Winthrop-University Hospital, Stony Brook School of Medicine, State University of New York at Stony Brook, Mineola, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Kim
authors.forename: M H
authors.initials: MH
authors.lastname: Gottesman
authors.forename: A
authors.initials: A
authors.lastname: Forero
authors.forename: D
authors.initials: D
authors.lastname: Han
authors.forename: D W
authors.initials: DW
authors.lastname: Myers
authors.forename: R
authors.initials: R
authors.lastname: Forlenza
authors.forename: J
authors.initials: J
authors.lastname: Golzarian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000401:mortality; D003128:Coma / Q000209:etiology*; D005260:Female; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology*; D013350:Subclavian Vein; D013577:Syndrome