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Pacemaker Wire Central Venous Stenosis and One More Reason to Not Run Central Venous Catheters for Dialysis in Reverse Flow

Authors


Address correspondence to: Stephen R. Ash, Nephrology, Indiana University Health Arnett, and Ash Access Technology, Lafayette, Indiana, e-mail: sash@hemocleanse.com

Abstract

A 75-year-old man on chronic peritoneal dialysis had unrecognized stenosis of the superior vena cava (SVC) due to pacemaker wires placed 5 years earlier. The patient was placed on hemodialysis after hernia surgery. When a tunneled central venous catheter for dialysis was placed from the right internal jugular (IJ) vein, the venous lumen extended through the stenotic area but not the arterial lumen. Probably due to a subsequent clot at the arterial lumen port the patient developed SVC syndrome and when the catheter was run in the reversed flow direction he developed hypovolemic shock. The stenosis and SVC syndrome resolved with angioplasty of the SVC stenosis, removal of the IJ catheter and use of a femoral vein catheter. The patient eventually returned to peritoneal dialysis and the femoral catheter was removed.

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