Abstract

Case Report

Hemoptysis after subclavian vein puncture for pacemaker implantation: A case report

Dioum M*, Sarr EM, Manga S, Mingou JS, Diack A, Diop AD, Bindia D, Diagne PA, Sarr AN, Diop IB, Avishek Bagchi, Rajendra Kumar Agarwal, Kewa and Kishan Talwar*

Published: 15 November, 2019 | Volume 4 - Issue 3 | Pages: 192-194

Background: Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only.

Case Summary: A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days.

Discussion: Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001065 Cite this Article Read Full Article PDF

Keywords:

Case report; Subclavian venous access; Alveolar hemorrhage; Hemoptysis; Chest x-ray

References

  1. Solomon N, Escher DJ. A rapid method for insertion of the pacemaker catheter electrode. Am Heart J. 1963; 66: 717–718. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14083795
  2. McNeill GP, Taylor NC. Use of subclavian vein for permanent cardiac pacing. Br Heart J. 1978; 40: 114–116. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/637961
  3. Kirk AJ, Turner MA. Surgical aspects of permanent cardiac pacemakers. Life Support Syst. 1987; 5: 223–231. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3695582
  4. Kossaify A, Nicolas N, Edde P. Hemoptysis after subclavian vein puncture for pacemaker implantation: importance of wire-guided venous puncture. Clin Med Insights Case Rep. 2012; 5:119-122. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22859867
  5. Talwar KK, Agarwal R, Rao YV. Permanent pacing by percutaneous subclavian vein in small children. Am Heart J. 1991; 122: 1796. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1957790
  6. García-Anguiano Duque F, Marchena Gómez J, Servent Pedescoll R. Hemoptysis, a rare complication of punction-catheterization of the subclavian vein. Rev Clin Esp. 1994; 194: 202. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8008962
  7. Goldberg A, Inna Rosenfeld I, Marmor A. Hemoptysis—a rare complication of pacemaker implantation. Indian Pacing Electrophysiol J. 2008; 8: 75-76. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18270606
  8. Antonelli D, Atar S, Bloch L. Hemoptysis after subclavian vein puncture. Harefuah. 2007; 146: 744. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17990384
  9. Truong AT, Brown DL. Catastrophic hemothorax from lobar pulmonary artery puncture during attempted subclavian vein catheterization: the fallibility of venous blood aspiration. J Clin Anesth. 2009; 21: 377-378. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19700295
  10. Holt S, Kirkham N, Myerscough E. Haemothorax after subclavian vein cannulation. Thorax. 1977; 32: 101-103.
  11. Yelgec NS, Osken A, Turkkan C, Alper AT. Subclavian vein puncture-induced massive pulmonary hemorrhage and hemoptysis during pacemaker implantation. North Clin Istanb. 2018; 5: 254-255. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30688923
  12. Tokue H, Tokue A, Morita H, Yoshito T. Successful Interventional Management for Pulmonary Arterial Injury Secondary to Pacemaker Implantation. Case Rep Cardiol 2016; 2016:1–3. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27882248
  13. Dora SK, Kumar VK, Bhat A, Tharakan JA. Venogram-guided extrathoracic subclavian vein puncture. Indian Heart J. 2003; 55:637-640. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14989516
  14. Burri H, Sunthorn H, Dorsaz PA, Shah D. Prospective study of axillary vein puncture with or without contrast venography for pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol. 2005; 28 Suppl 1: S280-283. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15683516

Figures:

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