K. Quillen et al., VASCULAR EROSION CAUSED BY A DOUBLE-LUMEN CENTRAL VENOUS CATHETER DURING THERAPEUTIC PLASMA-EXCHANGE, Transfusion, 35(6), 1995, pp. 510-512
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.