Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: a case report and review of the literature

• Published in: British journal of anaesthesia : BJA Vol. 99; no. 3; pp. 384 - 388
• Main Authors: Orme, R. M. L’E., McSwiney, M.M., Chamberlain-Webber, R.F.O.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2007; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Tamponade - etiology; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; complications, catheter migration; complications, death; equipment, cannulae intravascular; Fatal Outcome; Female; Fluid Therapy - adverse effects; Fluid Therapy - methods; Foreign-Body Migration - complications; heart, tamponade; Humans; Hyperkalemia - etiology; ions, potassium; Medical sciences; Postoperative Complications; ions, potassium; heart, tamponade; complications, death; equipment, cannulae intravascular; complications, catheter migration; Intravenous administration; complications; Cardiac tamponade; Catheter; tamponade; ions; Cardiovascular disease; Ions; catheter migration; complications; Inorganic element; Case study; cannulae intravascular; heart; Heart disease; Pericardial disease; Anesthesia; Complication; Potassium; death; equipment
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aem181

We present a case of fatal cardiac tamponade that occurred in association with a peripherally inserted central catheter (PICC) inserted from the right antecubital fossa. Migration of the catheter from the right atrium within 24 h of insertion lead to the administration of a potassium-enriched sodium chloride solution into the pericardial space with the development of ST-segment elevation and progression to pulseless electrical activity and, subsequently, ventricular fibrillation. Although signs of tamponade were seen on echocardiography, we propose that myocardial hyperkalaemia from the diffusion of potassium through the epicardium accounted for some of the clinical picture. PICC lines carry a greater risk of migration because of the tip movement associated with arm abduction and, therefore, care must be taken to ensure that the catheter tip is correctly positioned to reduce this risk. When such catheters are used for intra-operative central venous access, we believe chest radiography is mandatory before fluid administration through the catheter, but that this is unnecessary when the catheter is being used solely for central venous pressure monitoring. The use of softer catheters may reduce the risk of vessel perforation. Once tamponade is suspected, all drugs and infusions administered via the catheter should be reviewed, the catheter aspirated and echocardiography performed urgently. This may be facilitated by the greater availability of limited bedside echocardiography within critical care units and theatre complexes.