Cardiac Tamponade From Misplaced Central Venous Line in Pericardiophrenic Vein

Authors:
  • THTimon W van Haeften
    Timon W van Haeften
  • EPElizabeth C. M. van Pampus
    Elizabeth C. M. van Pampus
  • HBHendrik Boot
    Hendrik Boot
  • RSRobert J. M. Strack van Schijndel
    Robert J. M. Strack van Schijndel
  • LTLambertus G. Thijs
    Lambertus G. Thijs
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Abstract
• A patient in whom a left internal jugular vein catheter had first migrated into the left pericardiophrenic vein, and subsequently had perforated Into the pericardium leading to a cardiac tamponade is described. Although this malposition has rarely been reported, It does not seem to be so infrequent, as three other similar misplacements have occurred in our institution. This malposition can be prevented by a high degree of suspicion, preferential use of the right internal jugular vein for catheterization, routine use of a J-tipped guidewire, limiting the depth of insertion of the guidewire during cannulation, routine roentgenographic control of radiopaque catheters, and (slow) injection of a small volume of radiopaque dye through the central venous catheter. (Arch Intern Med 1988;148:1649-1650)