Abstract
BackgroundA 72 year old male was admitted to the medical intensive care unit with septic shock.Case presentationA left subclavian central venous catheter was inserted on the day of admission whose tip was pushing against the wall of the vessel lumen. The patient's condition improved with treatment, but three days later had a new episode of acute hypotension. CT scan of the chest showed that the catheter had eroded through the superior vena cava wall.ConclusionThe catheter was pulled out and patient recovered from the complication with supportive therapy. Care should be taken that the tip of the catheter is in the center of the vessel lumen to avoid this rare, but potentially life threatening, complication.
Highlights
A 72 year old male was admitted to the medical intensive care unit with septic shock.Case presentation: A left subclavian central venous catheter was inserted on the day of admission whose tip was pushing against the wall of the vessel lumen
We report here an uncommon complication associated with the insertion of central venous catheters
The patient was initially admitted to a general medical floor, but his condition worsened within 24 hours and he went into septic shock and had to be transferred to the medical intensive care unit
Summary
Central venous catheters are placed in patients every day in intensive care units, more than 5 million every year just in the United States alone.[1]. The patient was initially admitted to a general medical floor, but his condition worsened within 24 hours and he went into septic shock and had to be transferred to the medical intensive care unit He was hypotensive, tachycardic and tachypnic and had evidence of disseminated intravascular coagulation from sepsis. Appropriate antibiotics were started, and he was treated aggressively with intravenous fluids and needed norepinephrine infusion for adequate blood pressure maintenance He had a left subclavian central venous catheter inserted on the day of admission to the intensive care unit for administration of the vasopressor agent While he was being supported by aggressive resuscitative therapy, he had a chest radiograph done as part of the work up to diagnose the etiology of acute deterioration in the clinical condition.
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