Cardiothoracic emergencies associated with subclavian hemodialysis catheters.

Three adults have had life-threatening perforations of the vena cava or right atrium associated with the use of subclavian hemodialysis catheters. Subclavian hemodialysis catheters should be meticulously positioned in the superior vena-caval lumen so the tip does not tent the vena-caval wall. If a patient with a subclavian hemodialysis catheter experiences unexplained and refractory hypotension, especially during hemodialysis, cardiac or vena-caval perforation should be suspected.