Perforation of the heart by central venous catheters in infants: guidelines to diagnosis and management.

The frequent use of central venous catheters has resulted in improved monitoring and parenteral nutrition. However, these catheters have also been a source of numerous complications, some of them lethal. Two cases of perforation of the heart that resulted in cardiac tamponade and death are reported. Early detection of this complication depends on a high index of suspicion, both clinical and radiographic. Measures such as securing the catheter tip in the superior vena cava can prevent this complication; immediate evacuation of the pericardial fluid by gentle aspiration or pericardiocentesis can prove life-saving.