Perforation of right ventricle and pericard by a central venous catheter during total parenteral nutrition

Fatal perforation of the right ventricular wall and pericardiac sac without presence of pericardiac tamponade by a central venous catheter is reported. The various events leading eventually to this catastrophic complication, such as malpositioning of the catheter tip, and its migration with the patient movements, are discussed. More frequent radiologic checks of the catheter tip, the use of silicon rubber catheters, and restriction of the patient's movements are recommended to avoid this fatal complication.