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The Journal of Bone and Joint Surgery, Vol 73, Issue 10 1503-1506, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Pericardial tamponade secondary to perforation by central venous catheters in orthopaedic patients

V Kalen, TA Medige and LA Rinsky
Department of Orthopaedics, College of Medicine, University of Florida, Gainesville 32610.

Pericardial tamponade from an indwelling central venous catheter developed in four orthopaedic patients. Two of these patients died acutely, and the other two sustained severe anoxic brain injury. The early signs of tamponade include tachycardia, hypotension, and increased central venous pressure. The outcome most often is fatal. When a central venous catheter has been placed incorrectly or has migrated, it can perforate the heart and produce pericardial tamponade. To avoid this complication, the tip of the catheter must be placed within the superior vena cava rather than the right atrium, and the position of the catheter must be ascertained with a radiograph of the chest. Prompt recognition and treatment of pericardial tamponade are imperative if a disastrous outcome is to be prevented.
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