Delayed Hydrothorax Following Percutaneous Central Venous Cannulation

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Abstract
Isolated cases of delayed complications associated with prolonged use of percutaneous central venous lines have been reported. Four patients developed hydrothorax more than 24 h after central venous cannulation due to perforation of an intrathoracic vein wall by the catheter tip. The patients were all adults of average body habitus. Left-sided catheters were placed in the operating room after anesthetic induction by experienced personnel using the Seldinger technique and secured in position with a dressing and tape. Chest x-rays taken in the recovery room showed all catheter tips terminated in the central vein and no evidence of hydrothorax. Hydrothorax was manifested in the post-operative period and occurred 1-7 days postcannulation. The delayed hydrothorax resulted from gradual penetration of the vein wall by the catheter tip. A combination of factors probably contributed to the vein wall erosion. The insecure fixation of the catheter combined with head, neck and cardiopulmonary motion resulted in the back-and-forth movement of the catheter tip. The stiff catheters in the left jugular system take a curved course to the superior vena cava bringing the catheter tip into close proximity to the wall of the superior vena cava. Late developing hydrothorax can be minimized by using a soft, pliable catheter, sutured firmly in place. Right-sided line placement is preferable to left-sided placement because of the anatomic relationships.