THE CVC REMOVAL DISTRESS SYNDROME - AN UNAPPRECIATED COMPLICATION OF CENTRAL VENOUS CATHETER REMOVAL

The removal of a central venous catheter (CVC) can be complicated by r are but potentially life-threatening neurocardiopulmonary distress. Th e clinical courses of eight patients who had CVC removal complications are reviewed. Seven patients had catheter removal from the right inte rnal jugular vein, and one from the right subclavian vein. The complic ations occurred after complete removal of the catheter (four patients) , after guidewire replacement for catheter change (three patients), an d after detachment of the hemostasis side port of the Swan introducer during sheath removal (one patient). Each of them had more than one co mplication. The major complications were: neurologic paresis or coma ( four patients), respiratory failure (four patients), and shock (two pa tients). One patient died of pulmonary sepsis. The overall mortality r ate was 12.5 per cent. Guidelines for safe removal of central venous c atheters are proposed. Possible mechanisms of the complications are di scussed. We refer to the observed complications as the CVC removal dis tress syndrome.