Kebede Abenezer A, Gerba Nigatu A, Gebremedhin Kibrom M, Desalegn Mahlet M, Gebre Yididiya G, Endashaw Mekbib B, Muche Selamawit T, Demeke Feven T, Weldemeskel Hiwot M
Department of Internal Medicine, MeQrez General Hospital, Addis Ababa, Ethiopia.
Department of Radiology, MeQrez General Hospital, Addis Ababa, Ethiopia.
J Med Case Rep. 2025 Jun 1;19(1):262. doi: 10.1186/s13256-025-05318-8.
Central venous catheters play a vital role in managing critically ill patients by providing reliable access for fluid resuscitation, medication delivery, hemodialysis, and hemodynamic monitoring. While insertion-related complications such as pneumothorax and vascular injury are well described, adverse events following catheter removal are less commonly recognized in clinical practice. These post-removal complications, though rare, can be life-threatening if not promptly identified. This report presents a rare case of hemothorax occurring immediately after the removal of a subclavian central venous catheter that was previously inserted for hemodialysis in a recently established hospital in a developing country.
A 30-year-old Ethiopian female patient with chronic kidney disease and hypertension, undergoing hemodialysis via a right subclavian venous catheter for the past 2 weeks, presented with difficulty initiating dialysis during her fourth session. upon the suspicion of catheter malfunction, the central line was removed. Then, 20 minutes later, the patient developed shortness of breath, right-sided pleuritic chest pain, and a drop in blood pressure. Physical examination revealed absent air entry over the right lung field. Chest x-ray confirmed a right hemothorax, and hemoglobin decreased from 6.5 mg/dL to 5.1 mg/dL within 4 hours. A chest drain was inserted, evacuating 700 mL of blood. Following blood transfusions, the patient's condition stabilized, and the chest tube was removed on day 8 after nearly complete hemothorax resolution. The patient was discharged on day 9 with significant improvement.
This case highlights the potential for complications to arise not only during central venous catheter insertion but also during removal. Clinicians should ensure proper catheter positioning during insertion and implement post-removal monitoring protocols to detect rare but potentially life-threatening complications such as hemothorax.
中心静脉导管在危重症患者的管理中发挥着至关重要的作用，可为液体复苏、药物输注、血液透析及血流动力学监测提供可靠的通路。虽然诸如气胸和血管损伤等与置管相关的并发症已有详细描述，但在临床实践中，导管拔除后的不良事件却较少被认识到。这些拔除后并发症虽罕见，但如果未能及时识别，可能会危及生命。本报告介绍了一例在发展中国家一家新建医院中，因血液透析而先前插入的锁骨下中心静脉导管拔除后立即发生血胸的罕见病例。
一名30岁患有慢性肾脏病和高血压的埃塞俄比亚女性患者，在过去2周内通过右锁骨下静脉导管进行血液透析，在第四次透析过程中出现启动透析困难。怀疑导管故障后，拔除了中心静脉导管。随后，患者出现呼吸急促、右侧胸膜炎性胸痛和血压下降。体格检查发现右肺野无呼吸音。胸部X线证实为右侧血胸，血红蛋白在4小时内从6.5mg/dL降至5.1mg/dL。插入胸腔引流管，引出700mL血液。输血后，患者病情稳定，在血胸几乎完全消退后的第8天拔除胸腔引流管。患者于第9天出院，病情显著改善。
本病例突出了不仅在中心静脉导管插入期间，而且在拔除期间都可能出现并发症。临床医生应确保置管期间导管位置正确，并实施拔除后监测方案，以检测诸如血胸等罕见但可能危及生命的并发症。
