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    "textoCompleto" => "<p class="elsevierStylePara">To the editor&#58;</p><p class="elsevierStylePara">Temporary or permanent central venous catheterization is commonly performed in in hemodialysis patients when an internal vascular access is not available&#46; Internal jugular vein catheterization is nowadays the preferred vascular access because it is associated to lower risks and complications &#40;15&#37; of mechanical&#44; infectious or thrombotic complications&#41;&#46; The most frequent mechanical complications are arterial puncture and secondary hematoma&#46; By contrast&#44; hemothorax and pneumothorax incidence is lower than 0&#44;0&#46;2&#37; and it happens immediately after the puncture&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">We present a 72 year-old woman with a history of high blood pressure and CRF secondary to nephroangiosclerosis in on hemodialysis since 2000&#46; The patient had a permanent catheter in within the right jugular vein&#44; which was placed 5 years ago&#46; The catheter was non-functioning&#44; permeation was not possible with the use of urokinase and the catheter had to be removed&#46; Due to the lack of an internal vascular accesses&#44; a temporary catheter&#44; which was shorter than usual &#40;16 cm instead of 19 cm&#41;&#44; was placed in the left jugular vein&#46; An X-ray film confirmed that the catheter was appropriately placed&#46; Nineteen days later it was removed because it did not work properly and was changed by means of a metal wire &#40;16 cm&#41;&#46; No radiological control was made&#46; During the following hemodialysis sessions the catheter flow was always lower than 200 mL&#47;min&#44; and the catheter was repeatedly manipulated&#46;</p><p class="elsevierStylePara">The patient came 29 days later to hemodialysis referring dyspnea and pain in on her right scapula&#46; At the beginning of the session clear fluid was obtained through the arterial branch and hematic fluid through the venous branch&#46; A chest X-ray film was made &#40;fig&#46; 1&#41;&#44; which showed right pleural effusion&#46; Dialysis was performed without heparin through a right femoral access&#46; Fifteen minutes after the end of hemodialysis the patient referred sudden right chest pain and dyspnea and she suffered cardiopulmonary arrest&#46; On physical exam right pulmonary hypoventilation was evident&#46; A decrease of hemoglobin value was detected on blood analysis&#44; and the right pulmonary field was opaque on chest X-ray&#46; The diagnosis of massive hemothorax was suspected&#44; a drain tube was placed and resuscitation maneuvers were initiated&#46; The patient was referred to the ICU&#44; where she spent 72 hours and after that she was admitted to our Department with no consequences&#46;</p><p class="elsevierStylePara">Internal jugular vein catheterization is not free from complications&#46; Massive hemothorax is not frequent&#44; occurs immediately after the puncture and commonly after catheterization of the subclavian vein&#46; In the reported case&#44; hemothorax happened 29 days after catheterization of the vascular access&#46; That was due to the removal of the left jugular catheter&#44; that was occluding a fistula created by the impact of the catheter&#46;</p><p class="elsevierStylePara">Several facts were determinants for perforation into the interpleural space&#58;<span class="elsevierStyleSup">3</span> canalization of the left jugular vein instead the right one &#40;that was occupied by a permanent catheter&#44; which had to be removed&#41;&#44; the replacement by a short catheter &#40;16 cm&#41; and the various manipulations of the catheter because of the low flow&#46; Massive hemothorax was the consequence of the catheter removal&#44; and perhaps this procedure should have been done with some precautions &#40;removal in the ICU&#41;&#46;</p><p class="elsevierStylePara">The widespread use of catheters for hemodialysis in patients with difficult vascular accesses increases the morbimortality&#46; It is mandatory the referral of the patient to the nephrology department&#44; and the cooperation of vascular surgeons and radiologists to achieve appropriate vascular accesses&#46;</p><p class="elsevierStylePara">A radiological control should be made after catheterization and replacement of the catheter to assess the correct position and the lack of complications&#44; although some authors do not agree with this measure&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">In summary&#44; when placing temporary catheters the appropriate length&#44; the correct position after placement and replacement should be considered&#44; and manipulations should be avoided&#46; </p>"
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Late-onset hemothorax after left jugular vein catheterization for hemodialysis
Hemotórax tardío tras la implantación de catéter yugular izquierdo para hemodiálisis
Pilar Fraile Gómeza, P.. G. Cosmesa, V.. García-Bernalta, J. M.. Taberneroa
a Servicio de Nefrología, Hospital Universitario de Salamanca, Salamanca, Salamanca, España,
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