An unexpected left hydrothorax after left internal jugular venous catheterisation for total parental nutrition and antibiotics.

Introduction Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion of central venous lines despite the advances made in the design, material of the catheter and the technique of insertion. Vascular erosion from the catheter is a rare complication that is identified late due to preexisting underlying pleural effusion or lack of awareness of this complication. This case report describes a complication that had occurred after an antibiotic coated triple lumen 7F 20-cm Cook’s® catheter was inserted into the left internal jugular vein in a cachexic patient with ovarian malignancy. Reports of ipsilateral pleural effusion following misplacement of central lines are not unusual but it is, however, rarely reported in our institutions. Two cases were detected in 1 institution but they were not reported. The last known cases of similar complications were reported in other institutions more than 10 years ago. It accounted for about 0.5% of known complications related to the insertion of central line.1 Other complications such as pneumothorax, malpositioning of lines and haemothorax are more commonly seen and occurred in up to 3% of all cases.1-6 Total parenteral nutritional infusion was infused via the proximal port of the new central line. The tip of the old central line and blood culture grew MRSA (methicillinresistant Staphylococcus aureus) and vancomycin was started and infused subsequently through the middle port. All infusion fluid was given via the triple lumen catheter due poor venous access.