PERICARDIAL TAMPONADE AND DEATH FROM HICKMAN CATHETER PERFORATION

In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter, Her internist planned pa lliative chemotherapy for metastatic breast cancer. Using the Seldinge r technique, the right subclavian vein was entered and a Hickman cathe ter was placed. Shortly after extubation and arrival in the postoperat ive recovery unit, the patient had respiratory and cardiac arrest. Res uscitative efforts, including chest tube placement and pericardiocente sis, were unsuccessful, Autopsy findings included perforation of the s uperior vena cava, with extension of the catheter in the pericardial s ac and associated effusion. Despite the low reported incidence of perf oration during placement of central venous catheters, we recommend con firmation of placement by fluoroscopy and instillation of radiopaque d ye because of the high mortality associated with this complication.