VASCULAR EROSION CAUSED BY A DOUBLE-LUMEN CENTRAL VENOUS CATHETER DURING THERAPEUTIC PLASMA-EXCHANGE

Background: The use of large-bore double-lumen dialysis catheters has simplified the procedure of therapeutic plasma exchange, but these cat heters are associated with unusual and possibly life-threatening compl ications. Case Report: A 46-year-old black man was admitted to the hos pital with acute onset of paresthesia and weakness. A diagnosis of Gui llain-Barre syndrome was made. Plasma exchange therapy was instituted by peripheral venous access. After three such exchanges, a double-lume n central venous catheter was placed via the left subclavian vein on h ospital Day 7. The patient experienced a sudden onset of severe chest pain and dyspnea during the fourth plasma exchange. He became diaphore tic and hypotensive and experienced tachycardia. The apheresis procedu re was stopped. Because of worsening respiratory distress, endotrachea l intubation was performed. A chest x-ray revealed a large right pleur al effusion. The central venous catheter was removed. A chest tube was placed, and a large amount of bloody fluid was drained. Several days later, the endotracheal and chest tubes were removed. Conclusion: An u nusual complication of the use of a central venous catheter, erosion o f the superior vena cava, occurred during therapeutic plasma exchange. Prompt recognition of this complication and appropriate therapy can b e life-saving.