Digging Deeper to Diagnose: Cardiac Tamponade Following Tunneled Dialysis Catheter Placement

Central venous catheter (CVC) placement is a common medical intervention in hospitalized patients associated with a host of complications, including cardiac tamponade. Here, we describe a case of a 61-year-old male with end-stage renal disease on hemodialysis via a right internal jugular tunneled dialysis catheter who presented to the emergency room for hypoxia at his skilled nursing facility. He had been discharged three days prior for treatment of a Methicillin-resistant Staphylococcus aureus (MRSA) neck abscess, during which an uncomplicated right internal jugular tunneled dialysis catheter exchange was performed one day prior to discharge. On admission, bedside point-of-care ultrasound (POCUS) showed a pericardial effusion without tamponade physiology. While receiving hemodialysis on his second day of admission, he was noted to have new hypotension, and repeat POCUS was concerning for tamponade. An urgent pericardiocentesis was performed with 895 mLs of serosanguinous drainage, followed by an additional 1400 mLs of serosanguinous drainage over the next 48 hours. Interventional radiology noted a contrast leak at the distal superior vena cava at the cavoatrial junction and suspected that the etiology for hemopericardium was an endovascular injury from tunneled dialysis catheter placement.