Fatal pericardial tamponade by a guide wire during jugular catheter insertion.

A case of fatal cardiac tamponade caused by superior vena cava perforation complicating left internal jugular vein catheterization and infusion is reported. Two cases of nonfatal combined hydromediastinum and hydrothorax as a result of the left-sided approach are discussed. Unexplained hypotension with venous distention in a patient with a central venous catheter should immediately raise the possibility of cardiac tamponade. Avoidance of the left internal jugular vein approach, the use of flexible catheter materials, and localization of the catheter tip above the pericardial reflection will lessen the complications caused by placement of central venous lines.