open access

Vol 45, No 2 (2013 Apr-Jun)
Case reports
Submitted: 2013-07-05
Accepted: 2013-07-05
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Hemothorax as a complication of subclavian vein cannulation with haemodialysis catheter — case report

Waldemar Iwańczuk, Piotr Guźniczak, Jarosław Kasperczak
DOI: 10.5603/AIT.2013.0020
·
Anaesthesiol Intensive Ther 2013;45(2):89-92.

open access

Vol 45, No 2 (2013 Apr-Jun)
Case reports
Submitted: 2013-07-05
Accepted: 2013-07-05

Abstract

We present the case of a 39 year-old male patient admitted to ICU with symptoms of acute metabolic acidosis. He was investigated for the presence of methanol and glycol. Conservative treatment was initially started, followed by haemodialysis. During insertion of a temporary haemodialysis catheter in a location of Haapaniemi and Slatis, the patient was conscious but restless; therefore sedation was required to continue the procedure. After three hours of haemodialysis, the patient’s general condition suddenly deteriorated. Hypovolemic shock and acute respiratory distress led to hypothesis of right haemothorax, which was rapidly confirmed by angio-CT examination. Trachea was intubated, drainage of right pleura was performed and aggressive fluid treatment begun. The patient was admitted to the operating theatre, and thoracotomy with reconstruction of damaged right venous angle was carried out. After the operation, the patient was transferred to ICU. He was mechanically ventilated and remained haemodynamically unstable. Although fluids and blood-made concentrates were transfused and catecholamines continuously administered, his clinical condition deteriorated and finally the patient died. We found two independent causes of this fatality: hypovolemic shock and acute extrinsic metabolic acidosis. However, this paper focuses on the problem of the iatrogenic complication, which was haemothorax. In the literature there are described examples of such cases. Authors emphasise the most traumatic moment of cannulation as being insertion of the guidewire and dilator to perform a tunnel for the catheter. Puncture by needle and localisation of the central vein results in fewer complications. Furthermore, we strongly recommend monitoring patients after central veins cannulation. All sudden deteriorations in clinical condition should be followed by meticulous diagnosis for the presence of this life-threatening complication.

Abstract

We present the case of a 39 year-old male patient admitted to ICU with symptoms of acute metabolic acidosis. He was investigated for the presence of methanol and glycol. Conservative treatment was initially started, followed by haemodialysis. During insertion of a temporary haemodialysis catheter in a location of Haapaniemi and Slatis, the patient was conscious but restless; therefore sedation was required to continue the procedure. After three hours of haemodialysis, the patient’s general condition suddenly deteriorated. Hypovolemic shock and acute respiratory distress led to hypothesis of right haemothorax, which was rapidly confirmed by angio-CT examination. Trachea was intubated, drainage of right pleura was performed and aggressive fluid treatment begun. The patient was admitted to the operating theatre, and thoracotomy with reconstruction of damaged right venous angle was carried out. After the operation, the patient was transferred to ICU. He was mechanically ventilated and remained haemodynamically unstable. Although fluids and blood-made concentrates were transfused and catecholamines continuously administered, his clinical condition deteriorated and finally the patient died. We found two independent causes of this fatality: hypovolemic shock and acute extrinsic metabolic acidosis. However, this paper focuses on the problem of the iatrogenic complication, which was haemothorax. In the literature there are described examples of such cases. Authors emphasise the most traumatic moment of cannulation as being insertion of the guidewire and dilator to perform a tunnel for the catheter. Puncture by needle and localisation of the central vein results in fewer complications. Furthermore, we strongly recommend monitoring patients after central veins cannulation. All sudden deteriorations in clinical condition should be followed by meticulous diagnosis for the presence of this life-threatening complication.

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Keywords

cannulation, subclavian vein, haemodialysis catheter, complication, haemothorax

About this article
Title

Hemothorax as a complication of subclavian vein cannulation with haemodialysis catheter — case report

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 45, No 2 (2013 Apr-Jun)

Pages

89-92

DOI

10.5603/AIT.2013.0020

Bibliographic record

Anaesthesiol Intensive Ther 2013;45(2):89-92.

Keywords

cannulation
subclavian vein
haemodialysis catheter
complication
haemothorax

Authors

Waldemar Iwańczuk
Piotr Guźniczak
Jarosław Kasperczak

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