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Kidney Week

Abstract: PO1359

Perforation of Superior Vena Cava: A Rare Complication of Tunneled Hemodialysis Catheter Placement

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Author

  • Sharma, Mukesh K., Sierra Nevada Nephrology, Reno, Nevada, United States
Introduction

Placement of tunneled hemodialysis catheter (TDC) is a fairly common procedure performed in hospitals and outpatient vascular centers. It is considered a fairly simple and risk free procedure for most part. Perforation of SVC while passing guide wires or dilating the tract is very rare and has been reported only in a very few case reports in the literature. We report a case that highlights this rare but frightful complication. This case also highlights the risk of deep central vein thrombosis associated with dialysis catheters.

Case Description

A 40-year-old female had a left subclavian vein temporary HD catheter placed in ER for emergent HD for ethylene glycol poisoning related complications. After one week, the temporary HD catheter was exchanged for a TDC under fluoroscopy. Shortly after the procedure the patient became dyspneic, tachycardic, and hypotensive. Imaging revealed perforation of SVC by the catheter tip resulting in a large Rt hemothorax. Immediate chest tube was placed followed by Thoracotomy and repair of SVC perforation and removal of TDC. One week later she developed left arm swelling and was diagnosed with deep vein thrombosis of the left subclavian vein, left internal jugular vein and the left axillary vein. The patient continued HD through a femoral HD catheter. She was started on heparin drip and systemically anticoagulated. The renal functions eventually recovered and arm swelling resolved and she was able to be discharged from hospital.

Discussion

Teaching Points:
This case highlights rare but frightful complications of placement of a tunneled hemodialysis catheter, especially involving the left side neck veins. SVC perforation is a potentially fatal complication that can occur during placement of HD catheters. Immediate recognition, chest tube insertion for drainage, and/or pericardiocentesis along with emergent SVC repair are the key factors to management. Given the high frequency of HD catheter placements, providers should be aware and know how to treat and manage these complications in a timely manner.