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Perforation of the superior vena cava after subclavian catheterization: a rare complication after autologous PBSCT

Bone Marrow Transplantation volume 43, pages 891–892 (2009)Cite this article

Central venous access is necessary for the management of patients undergoing high-dose chemotherapy with autologous PBSCT. These devices are used for indications such as administration of blood products, chemotherapy, parenteral nutrition and infusion fluids.1 Moreover, catheters may also be used for the collection of PBSC.2 Complications of catheterization include mechanical (arterial puncture and pneumothorax), thrombotic and infectious problems.

Perforation of the SVC by an i.v. catheter is a rare,3 but significant clinical complication. This may induce hemothorax, hydrothorax, pneumothorax, hydromediastinum and pneumomediastinum.4, 5 The incidence of this complication seems to be about 0.5% of catheter placements, but many catheter tip perforations remain undetected or unreported.4, 6 Diagnosis is commonly delayed, which contributes to patient morbidity and mortality.4 Perforation may be the result of mechanical trauma from the catheter tip or chemical damage from infused solutions (hypertonic or vesicant agents).5 The time from catheter insertion to vascular perforation has a range of 1–60 days.4 In our case, the delay of 43 days between the catheter insertion and the features of perforation (chest pain and dyspnea) might have favored mechanical damage.

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Authors and Affiliations

  1. Centre National de Greffe de Moelle Osseuse, Tunis, Tunisia

    A Abdelkefi, O Ben Gaied, S Ladeb, L Torjman, A Lakhal & T Ben Othman

  2. Service d'Anesthésie-Réanimation de l'hôpital militaire, Tunis, Tunisia

    I Labbène & M Ferjani

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  1. A Abdelkefi
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  2. O Ben Gaied
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Correspondence to A Abdelkefi.

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Abdelkefi, A., Ben Gaied, O., Ladeb, S. et al. Perforation of the superior vena cava after subclavian catheterization: a rare complication after autologous PBSCT. Bone Marrow Transplant 43, 891–892 (2009). https://doi.org/10.1038/bmt.2008.407

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