Two Cases of Extravasation of Fluid as a Complication Associated with a Central Venous Catheterization

Akitoshi Kudoh, Kazuhisa Tokunoh, Katsuhiko Morita, Sakurao Hiraki and Shintarou Fukuda

Department of Surgery, Ube Industrial Central Hospital

We report 2 cases of extravasation of fluid that were rare complications of central venous (CV) catheter use. Case 1) A 66-year-old women reporting respiratory distress on day 5 of total parenteral nutrition (TPN). She became progressively hypoxic and acidositic, and had large bilateral pleural effusions and cardiac tamponade requiring emergency intubation. Chest CT showed free air nearby the tip of the CV catheter in the hydromediastinum, so we inferred that the air had been mixed through the bolus injection of drugs. We conducted bilateral thoracocentesis (right 2,300 ml, left 980 ml) and pericardiocentesis (300 ml), and removed the CV catheter immediately. Case 2) A 82-year-old woman reporting dyspnea on day 18 of TPN was found in chest ultrasonography to have right pleural effusion. Thoracocentesis yielded 350 ml of clear fluid, and the dyspnea improved dramatically. The glucose concentration of the fluid was 416 mg/dl and pleural effusion was blue 30 minutes after the injection of Indigocarmine through the CV catheter. After diagnosis, we removed the catheter. Patients both recovered. It is considered that the CV catheter might perforate the vessel wall of superior vena cava. When a patient suddenly becomes dyspneic and develops pleural effusion during TPN, care givers should suspect life-threatening fluid extravasation requiring immediate thoracocentesis, pericardiocentesis and CV catheter removal.

Key words
central venous catheter, intravenous hyper alimentation, extravasation of fluid

Reprint requests
Akitoshi Kudoh Department of Surgery, Ube Industrial Central Hospital
750 Nishikiwa, Ube, 755-0151 JAPAN

Accepted
November 30, 2004

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