Kim Esther H, Moolchandani Priyanka, Patel Satya
Internal Medicine, University of California Los Angeles, Los Angeles, USA.
Cureus. 2024 Sep 27;16(9):e70317. doi: 10.7759/cureus.70317. eCollection 2024 Sep.
Central venous catheter (CVC) placement is a common medical intervention in hospitalized patients associated with a host of complications, including cardiac tamponade. Here, we describe a case of a 61-year-old male with end-stage renal disease on hemodialysis via a right internal jugular tunneled dialysis catheter who presented to the emergency room for hypoxia at his skilled nursing facility. He had been discharged three days prior for treatment of a Methicillin-resistant Staphylococcus aureus (MRSA) neck abscess, during which an uncomplicated right internal jugular tunneled dialysis catheter exchange was performed one day prior to discharge. On admission, bedside point-of-care ultrasound (POCUS) showed a pericardial effusion without tamponade physiology. While receiving hemodialysis on his second day of admission, he was noted to have new hypotension, and repeat POCUS was concerning for tamponade. An urgent pericardiocentesis was performed with 895 mLs of serosanguinous drainage, followed by an additional 1400 mLs of serosanguinous drainage over the next 48 hours. Interventional radiology noted a contrast leak at the distal superior vena cava at the cavoatrial junction and suspected that the etiology for hemopericardium was an endovascular injury from tunneled dialysis catheter placement.
中心静脉导管（CVC）置入是住院患者常见的医疗干预措施，但会引发一系列并发症，包括心脏压塞。在此，我们描述一例61岁男性患者，他患有终末期肾病，通过右颈内静脉隧道式透析导管进行血液透析，因在其熟练护理机构出现缺氧情况而被送往急诊室。他在三天前因耐甲氧西林金黄色葡萄球菌（MRSA）颈部脓肿接受治疗后出院，出院前一天进行了一次无并发症的右颈内静脉隧道式透析导管更换。入院时，床旁即时超声（POCUS）显示有心包积液，但无心脏压塞的血流动力学改变。在入院第二天进行血液透析时，他出现了新的低血压，复查POCUS提示存在心脏压塞。遂紧急进行心包穿刺，抽出895毫升血性液体，随后在接下来的48小时内又引出1400毫升血性液体。介入放射科检查发现上腔静脉远端在腔房交界处有造影剂渗漏，怀疑心包积血的病因是隧道式透析导管置入导致的血管内损伤。
