Abdallah M. Almaghraby
Department of Cardiology – University of Alexandria - Egypt
Title: A catastrophe caused by central venous catheter insertion – A case report
Biography
Biography: Abdallah M. Almaghraby
Abstract
Central venous catheterization (CVC) is a routine technique done in critical care and emergency departments for monitoring patients and giving certain parenteral medications in special conditions.A 50-year-old male patient with no previous medical history presented to our hospital complaining of high grade fever with gradual onset and stationary course with no response to antipyretics and antibiotics for 1 week. Work-up for fever was unremarkable, mild renal impairment was accidentally diagnosed with Creatinine level of 2.8 mg/dl, fever subsided after giving intravenous antibiotics for 3 days then the patient developed hypotension, blood pressure was 70/40 mmHg, heart rate was 140 beats per minute, electrocardiogram showed sinus tachycardia, liver enzymes were elevated, serum bicarbonate level was very low so the intensive care specialist inserted a central venous catheter to guide his fluid status control, central venous pressure was very low so he received intravenous fluids together with the antibiotics. Chest X-ray was done a day later after central venous catheter insertion and astonishingly we found the introducing guide wire left inside his heart starting from the right internal jugular vein towards the right atrium and ventricle making a loop inside the pulmonary artery then down through the inferior vena cava towards the hepatic vein. The lost wire was retrieved blindly without fluoroscopic guidance and follow-up X-ray showed no residual wire parts, then he was referred to us for echocardiography and we found severe tricuspid valve regurgitation with no signs of chronicity with perforation of the anterior leaflet, no visible vegetations or thrombi, right and left ventricular systolic and diastolic functions were completely normal and no pericardial effusion. Two days later the patient was referred to us again for follow up as he was still hypotensive with elevated central venous pressure. The new echocardiography revealed severely reduced left ventricular systolic function with borderline dimensions and reduced right ventricular systolic function with normal dimensions.