Journal of the American College of Surgeons
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Pericardial tamponade caused by central venous catheter perforation of the heart is a catastrophic complication that can be prevented by attention to proper positioning of the catheter tip proximal to the cardiac silhouette. This study was performed to determine awareness of this potential complication among physicians and to suggest measures to minimize the incidence of this problem. ⋯ Pericardial tamponade resulting from central venous catheter perforation of the heart can be avoided by adherence to proper technique in the placement of these catheters, ensuring that the catheter tip lies proximal to the cardiac silhouette, optimally in the superior vena cava, 2 cm proximal to the pericardial reflection. Physicians who place these catheters and train others to do so must be aware of this issue and they must educate their trainees as well. Radiologists responsible for interpreting the roentgenographs of the chest obtained after catheter placement should be alert to catheter malposition and communicate this information promptly. Hospital protocols should deal with this issue explicitly and insist on repositioning of catheters if catheter tips are seen to lodge in suboptimal positions.