Unsuspected cardiac tamponade following insertion of a haemodialysis catheter: a normal chest radiograph does not exclude a complication

Extract

Introduction

Central venous cannulation is a commonly performed medical procedure, widely used in general internal medicine and nephrology. It is used for both therapeutic and diagnostic indications. As with all invasive procedures, it is associated with a number of recognized complications [1], and strategies have been developed to minimize them. Cardiac tamponade is one such complication [2]. It is thought to arise from the guidewire, dilator or venous cannula piercing the myocardial wall. Suggestions made to minimize the risk of perforation include the use of soft j‐tipped wires [3], ensuring that cannulae are not advanced too far or against resistance [2] and the use of post‐procedure chest radiographs to confirm correct positioning of the catheter [4].

We report a case of an undetected pericardial tamponade associated with the insertion of a haemodialysis catheter, despite a normal post‐insertion chest radiograph.

Case

A cachectic 42‐year‐old woman was admitted to the intensive care unit following the reversal of an ileal–jejunal bypass procedure which had been performed 11 years previously for morbid obesity. The initial operation had led to the desired weight loss but also eventually to hepatic failure manifested by malabsorbtion, peripheral oedema, a low serum albumin, hyperbilirubinaemia, elevated hepatic transaminases and a coagulopathy.