Abstract
We report 2 cases of extravasation of fluid that were rare complications of central venous (CV) catheter use. Case 1) A 66-year-old women reporting respiratory distress on day 5 of total parenteral nutrition (TPN). She became progressively hypoxic and acidositic, and had large bilateral pleural effusions and cardiac tamponaderequiring emergency intubation. Chest CT showed free air nearby the tip of the CV catheter in the hydrome-diastinum, so we inferred that the air had been mixed through the bolus injection of drugs. We conducted bi-lateral thoracocentesis (right 2, 300ml, left 980ml) and pericardiocentesis (300ml), and removed the CV cathe-ter immediately. Case 2) A 82-year-old woman reporting dyspnea on day 18 of TPN was found in chest ultra-sonography to have right pleural effusion. Thoracocentesis yielded 350ml of clear fluid, and the dyspnea im-proved dramatically. The glucose concentration of the fluid was 416mg/dl and pleural effusion was blue 30minutes after the injection of Indigocarmine through the CV catheter. After diagnosis, we removed the cathe-ter. Patients both recovered. It is considered that the CV catheter might perforate the vessel wall of superiorvena cava. When a patient suddenly becomes dyspneic and develops pleural effusion during TPN, care givers should suspect life-threatening fluid extravasation requiring immediate thoracocentesis, pericardiocentesis and CV catheter removal.
