Abstract Three cases are cited to illustrate the mechanism of cardiac perforation by an intact catheter with resultant hydropericardium and cardiac tamponade. The fatal outcome in two of the cases emphasizes the gravity of this complication of fluid administration via an intravenous catheter. Accidental advancement of the catheter tip can result from faulty insertion of the catheter or from movement of the patient's torso or arm after the catheter is in place. Insertion of the catheter should be on the basis of careful measurements. In estimating the distance from the site of venous cutdown to the junction of the superior vena cava with the right atrium, the crucial factor is the length of the vena cava, and this has been found by us to be related to the length of the sternum from the suprasternal notch to the xiphoid process. One third of this length, added to the distance from the venous cutdown site to the suprasternal notch, gives the length of catheter needed. The location of the catheter tip should be checked by periodic roentgenograms of the chest or by intracardiac electrocardiograms from an electrode at the tip of a Teflon®-coated wire placed through the polyethylene catheter if the catheter traverses a joint. Accidental advancement of the tip most often occurs during abduction of the arm containing the catheter and/or rotation of the torso toward that arm; therefore some restriction of motion is advisable. Also, to avoid the “creeping” of the catheters placed across actively moving joints we now prefer insertion via infraclavicular or supraclavicular venipuncture. The onset of hydropericardium and cardiac tamponade is signalled by a sudden drop in blood pressure, tachycardia, distension of neck veins, and an increase in central venous pressure. If this happens, fluid administration should immediately be stopped and pericardiocentesis carried out.
R. L. Brandt, W. Foley, G. Fink
American journal of surgery