Cardiac tamponade and cardiogenic shock after central venous catheter cannulation. Analysis of a case

Dear Editor,
Cannulation with central venous access catheters in hospitalized patients is a routine procedure, especially in the critical care area. However, the procedure that is not exempt from complications, some of them with serious repercussions for the life of the patient, and its success depends largely on the experience of the professional [1–3].
The incidence of complications related to the catheterization of a central vein vary between 10% and 20%. Cardiac tamponade is one example of such serious sequela, albeit very rare. Its incidence ranges between 0.14% and 0.30% with a high mortality rate, and from 37.5% to 100% if there is ventricle perforation [4, 5].
We present the case of a patient with cardiac tamponade, secondary to a first central venous access by ultrasound-guided Seldinger technique for the administration of parenteral nutrition.
An 84-year-old Spanish woman with a medical history of arterial hyper­tension, dyslipidaemia, and mild cognitive impairment with suspected Alzheimer’s disease was admitted to the hospital ward for a month due to severe acute cholecysto-pancreatitis, awaiting endoscopic retrograde cholangiopancreatography and qualified for parenteral nutrition for which a central venous catheter (CVC) was needed.
After laboratory test (with no apparent contraindications detected), obtaining consent, and aseptic preparation of the skin, a single, successful, ultrasound-guided puncture of the right internal jugular vein was performed under local anaesthesia with the patient in the Trendelenburg position. The Seldinger technique was used for cannulation of the vessel (triple-lumen 30 cm, 7 Fr, J-tip). During the procedure, the patient remained agitated due to poor tole­rance of the position and associated discomfort, as well as prior disorientation. After insertion of the catheter, parenteral nutrition was started following radiographic verification. Two minutes later, while the central line was being sutured to the skin, a decreased level of consciousness, agonal breathing, and bilious vomiting followed by respiratory arrest were observed. Urgent manoeuvres were performed to control the airway, escalating to emergency orotracheal intubation, with maintenance of arterial pulse and auscultation with bilateral preserved vesicular murmur.
Upon admission to the ICU the patient remained mechanically ventilated. The presence of pneumothorax was ruled out after performing serial urgent chest...


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