title: [Late mediastinitis with bilateral hydrothorax after vessel perforation by a central venous catheter].
abstract: A central venous catheter was inserted into the right internal jugular vein of a 67-year-old woman to provide parenteral nutrition on the 7th day after surgery. Five days later, mediastinitis with bilateral hydrothorax had developed and was causing respiratory failure and systemic inflammatory response syndrome secondary to documented vascular perforation by the catheter. Four factors have been associated with increased risk of perforation: catheter rigidity and diameter, the angle between the tip of the catheter and the vessel wall, and insertion from the left. Three catheter positions have been described as safe when radiologically confirmed: the superior vena cava, the point where the superior vena cava meets the atrium, and the midpoint of the innominate vein. However, it should not be forgotten that a radiograph is 2-dimensional and a single image of a catheter tip can correspond to a variety of locations (superior vena cava, vena innominata, extravascular location, and more). Even when there is clinical and radiologic evidence of catheter positioning, vascular perforation should be suspected in patients with a central venous catheter and bilateral pleural effusion who present respiratory insufficiency and hemodynamic instability.
authors.affiliation: Departamento de Anestesiología, Reanimación y Unidad del Dolor, Clínica Universitaria de Navarra, Pamplona. amartinezs@unav.es
authors.forename: A
authors.initials: A
authors.lastname: Martínez Simón
authors.forename: L A
authors.initials: LA
authors.lastname: López Olaondo
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríguez Paz
authors.forename: E
authors.initials: E
authors.lastname: Cacho Asenjo
authors.forename: F J
authors.initials: FJ
authors.lastname: Pueyo Villoslada
authors.forename: P
authors.initials: P
authors.lastname: Monedero Rodríguez
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D004751:Enteritis / Q000628:therapy; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery; D005334:Fever / Q000209:etiology; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007601:Jugular Veins / Q000293:injuries*; D010289:Parenteral Nutrition, Total / Q000295:instrumentation*; D010996:Pleural Effusion / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000209:etiology; D045169:Severe Acute Respiratory Syndrome / Q000209:etiology; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed