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Atrial perforation with the tip of the PICC line.
- Ivan Hronek MD (5 October 2007)
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Concentrated potassium chloride on ICU: don't give it as water!
- Tamas Szakmany (20 September 2007)
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Ivan Hronek MD, anesthesiologist SFMC, Los Angeles
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I view this as a very serious problem. The peripherally inserted central catheters in the assertion of the Center for Disease Control in Atlanta (last guidelines 2002)have a lower risk of infections as well as mechanical complications than centrally placed catheters. As a result they are viewed as non-problematic and their numbers rose tremendously. They may well be a cause of unrecognized sudden death in some patients. An international registry of the peripherally inserted central catheters should be instituted and number of such complications reviewed. Conflict of Interest:None declared |
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Tamas Szakmany, Locum Consultant in Anaesthesia and Intensive Care West Middlesex University Hospital, Twickenham Road, Isleworth, TW8 6AF, UK
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Editor – I was interested to read the case report describing fatal cardiac tamponade as a result of a PICC line (1). Apart from the discussion on the potential factors contributed to the migration of the catheter there is another very important lesson to be learnt. The authors agreed that the composition of the first solution administered via the PICC line might have contributed to the poor outcome. In my view it is clearly the case. The unnecessary and unsafe overuse of concentrated potassium chloride solution is well documented in the literature (2). Unfortunately, supplemental potassium administration is also the most common cause of severe or even fatal hyperkalaemia in patients who are hospitalized, and this risk must be kept in mind when one is initiating treatment (2). The risk is greatest with the administration of intravenous potassium, which should be avoided if possible. Oral potassium is safer, because potassium enters the circulation more slowly. In the case reported by Omar et al. the mild hypokalaemia could be have been treated with oral supplements (3). The first signs of pericardial tamponade were observed after the infusion of concentrated potassium chloride. It is likely that severe myocardial injury and fatal arrhythmia would not have developed if the fluid infused did not contain such high concentration of potassium. This case further underline the importance of limiting the use of concentrated potassium infusions in mild hypokalaemia (4). 1. Orme RM, McSwiney MM, Chamberlain-Webber RF. Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: a case report and review of the literature. Br J Anaesth 2007; 99: 384-8 2. Rimmer JM, Horn JF, Gennari FJ. Hyperkalemia as a complication of drug therapy. Arch Intern Med 1987; 147: 867-869 3. Gennari FJ. Hypokalemia. N Engl J Med. 1998; 339: 451-8 4. Hemstreet BA, Stolpman N, Badesch DB, May SK, McCollum M. Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety. Curr Med Res Opin. 2006; 22 :2449- 55 Conflict of Interest:None declared |
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