Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letter to the Editor
ARTICLE IN PRESS
doi:
10.4103/ijn.ijn_298_23

Tunneled Dialysis Catheter Perforating the Myocardium can Occur as a Delayed Complication

Department of Nephrology and Kidney Transplantation, TX Hospitals, Hyderabad, Telangana, India
Department of Radio-diagnosis, Niloufer Hospital, Hyderabad, Telangana, India
Corresponding Author: Dr. Praveen K. Etta, Department of Nephrology and Kidney Transplantation, TX Hospitals, Hyderabad, Telangana, India. E-mail: drpraveen85@gmail.com
Licence
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

How to cite this article: Etta PK, Thatipamula M. Tunneled Dialysis Catheter Perforating the Myocardium can Occur as a Delayed Complication. Indian J Nephrol. doi: 10.4103/ijn.ijn_298_23

Dear Editor,

Cardiac perforations from central venous catheters can be catastrophic and are usually noticed immediately after the catheter insertion. Here, we report a rare case of delayed catheter tip migration into the pericardial space due to a long-term tunneled hemodialysis (HD) catheter.

A 70-year-old female with end-stage kidney disease and on maintenance HD through right jugular tunneled HD catheter (14.5 Fr) which was inserted 9 months ago came for a routine HD session and was noticed to have aspiration of straw-colored fluid of about 15 ml from both the catheter ports with no blood flow. CT chest confirmed the catheter tip in the pericardial cavity perforating the inferior surface of the right atrium [Figure 1]. Echocardiogram did not show significant pericardial effusion. Under close supervision of a cardiac surgeon and taking control of the right atrial perforated site by taking purse string sutures after mini-thoracotomy, the tunneled catheter was pulled back by a few centimeters to keep the catheter tip in mid right atrial position. Purse string sutures were tightened after pulling the catheter out of the pericardial space. No major complications including hemopericardium were noted.

Figure 1:
High-resolution CT chest (a) topogram, (b) axial, and (c) reconstructed coronal images showing the tip of the tunneled dialysis catheter in the pericardial cavity.

Although rare, cardiac perforations from the catheters can be lethal and can lead to life-threatening complications such as pericarditis, pericardial effusion, hemopericardium, cardiac tamponade, and arrest. These most commonly arise early due to trauma from the introducer needle, guidewire (particularly if the stiffer side is inserted instead of the soft j-tipped end), dilators, or the catheter itself. The incidence of such complications was reduced in recent years due to new-generation catheters, and procedures were guided by ultrasonography or fluoroscopy. Perforations resulting from tunneled catheters can be catastrophic due to their larger diameter. The exact reasons for right atrial perforation as a delayed complication, after 9 months in our case are unknown. Probably with catheter migration or a deeper tip position into the right atrium indenting its inferior surface and with repeated cardiac contractions, the catheter tip might have eroded and perforated the right atrial wall. As the catheter itself acts as a barrier to bleeding, unsupervised manipulation or removal of these large bore catheters can be catastrophic as the perforated site can allow the entry of blood into the pericardium causing hemopericardium and catastrophic tamponade. Early recognition of this complication and proper management saved the patient from a potentially fatal situation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.


Fulltext Views
37

PDF downloads
16
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections