Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
Legal Medical Institute of Porto Velho, Civil Police of the State of Rondônia, Porto Velho, Brazil.
Forensic Sci Med Pathol. 2022 Sep;18(3):275-279. doi: 10.1007/s12024-022-00491-4. Epub 2022 Jun 13.
Fatal adverse events caused by any health professional as consequence of malpractice are uncommon. In this work, the authors report a fatal cardiac tamponade associated with a peripherally inserted central catheter (PICC) by the right jugular vein that perforated the right atrium of the heart. The diagnosis of cardiac tamponade was not detected in hospital during the intrapericardial infusion of total parenteral nutrition and was only registered during the autopsy. The postmortem examination showed a milky liquid inside the pericardial cavity compatible with the total parenteral nutrition administered. The catheter in its migration in the cardiac chambers, mechanically perforated the inner wall of the endocardium between the trabeculae carneae, continued its course between the myocardial fibers until it was externalized. In conclusion, cardiac tamponade, although it is an extremely rare medical complication, has a high risk of fatality specially if peripheral rather than central veins were cannulated.
由医疗过失导致的任何医疗专业人员引起的致命不良事件都不常见。在这项工作中，作者报告了一例因经右颈内静脉置入的外周中心静脉导管（PICC）刺穿心脏右心房而导致的心包填塞致死的病例。在心包内输注全胃肠外营养期间，医院未能检测到心包填塞的诊断，仅在尸检时才发现。尸检显示心包腔内有乳白色液体，与给予的全胃肠外营养相符。导管在向心腔迁移过程中，机械性地刺穿了肉柱之间的心内膜内层，在心肌纤维之间继续前进，直到穿出。总之，心包填塞虽然是一种极其罕见的医疗并发症，但如果是外周静脉而不是中心静脉置管，其死亡率风险特别高。
