Unexpected Tension Pneumothorax Complicated by Double-Lumen Catheter Insertion in Patient with Mechanical Ventilator: A Case Report

Arif Himmawan, Rullyano Hardian, Fitriah Sherly Marleen

Khidmat Sehat Afiat General Hospital of Depok

Koresponden: himmawan89@gmail.com

Abstract

Introduction: Tension pneumothorax is an emergency situation with a high mortality rate which can be caused by trauma/iatrogenic. We report a case of tension pneumothorax observed after insertion of a double-lumen cetheter in a patient on a mechanical ventilator.

Case: A 70 year old man with a mechanical ventilator was designed to install a double-lumen catheter in preparation for hemodialysis. After insertion of a double-lumen catheter, the patient’s saturation decreased, breath sounds from the right hemithorax decreased. A chest X-ray shows a collapsed right lung and flattened diaphragm. A needle thoracocentesis was performed at the 2nd ICS, the right mid-clavicular line, and continued with the installation of a WSD at the 5th ICS, the right anterior axilla line. The result is a clinical improvement.

Discussion: Tension pneumothorax is not an uncommon complication in mechanical ventilated patient, but its occurance immediately after insertion of a double-lumen cetheter is extremely rare. Subsequent decline in respiratory and cardiovascular function can be life-threatening if not detected early enough and managed properly. With the needle thoracocentesis and insertion of a WSD tube, the patient’s clinically condition significantly improved.

Conclusion: Tension pneumothorax is an emergency situation with a high mortality rate which can be caused by trauma/iatrogenic. With the needle thoracocentesis and insertion of WSD tube, a clinical improvement in the patient’s condition was evident.

Keywords: tension pneumothorax, double-lumen catheter, mechanical ventilator