Ho C M, Lui P W
Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, Republic of China.
J Clin Anesth. 1994 May-Jun;6(3):243-6. doi: 10.1016/0952-8180(94)90066-3.
We report a case of bilateral hydrothorax secondary to perforation of the superior vena caval wall, which was caused by a double-lumen central venous catheter used for catheterization of the left jugular vein. A patient undergoing craniectomy developed a right pleural effusion followed by a left hydrothorax 12 hours after the operation. There are several possible explanations for this phenomenon. The horizontal course of the left brachiocephalic vein, heart contraction, mechanical ventilation, changes in patient position, and solutions of high osmolality can promote vascular erosion by the catheter tip. High hydrostatic pressure in the thorax associated with a congenital or an acquired interpleural communication may cause bilateral hydrothorax. We suggest that it is always preferable to cannulate a central vein through the right side. When the left external jugular vein has to be cannulated, an intravascular ECG may be helpful to determine the position of the catheter tip. Chest roentgenogram should be obtained early to confirm catheter position. Furthermore, the distal port of the double-lumen central venous catheter should be used perioperatively for continuous surveillance of the central venous pressure waveform to ensure early warning of venous perforation.
我们报告一例因用于左颈静脉置管的双腔中心静脉导管导致上腔静脉壁穿孔继发双侧胸腔积液的病例。一名接受颅骨切除术的患者术后12小时出现右侧胸腔积液，随后出现左侧胸腔积液。对于这种现象有几种可能的解释。左头臂静脉的水平走行、心脏收缩、机械通气、患者体位改变以及高渗溶液可促使导管尖端侵蚀血管。与先天性或后天性胸膜间交通相关的胸腔内高静水压可能导致双侧胸腔积液。我们建议始终优先通过右侧进行中心静脉置管。当必须对左颈外静脉进行置管时，血管内心电图可能有助于确定导管尖端的位置。应尽早进行胸部X线检查以确认导管位置。此外，双腔中心静脉导管的远端端口应在围手术期用于持续监测中心静脉压波形，以确保对静脉穿孔进行早期预警。
