When one port does not return blood: two case reports of rare causes for misplaced central venous catheters / Quando uma porta não apresenta retorno sanguíneo: relato de dois casos de causas raras de mau posicionamento de cateter venoso central

We present two cases of misplaced central venous catheters having in common theabsence of free blood return from one lumen immediately after placement. The former is acase of right hydrothorax associated with central venous catheterization with the catheter tipin intra-pleural location. In this case the distal port was never patent. In the latter case therewas an increased aspiration pressure through the middle port due to a catheter looping.The absence of free flow on aspiration from one lumen of a central catheter should not beundervalued. In these circumstances the catheter should not be used and needs to be removed.

Apresentamos dois casos de mau posicionamento de cateter venoso central. Têmem comum a ausência do retorno sanguíneo livre em um dos lúmens imediatamente após acolocac¸ão. O primeiro é um caso de hidrotórax direito associado ao cateterismo venoso central,com a ponta do cateter em localizac¸ão intrapleural. Nesse caso, a porta distal nunca estevepatente. No segundo caso houve um aumento da pressão de aspirac¸ão através da porta medialpor causa da formac¸ão de alc¸a no cateter.A ausência de fluxo livre na aspirac¸ão de um lúmen do cateter central não deve ser subesti-mada. Nessas circunstâncias, o cateter não deve ser usado e deve ser removido.

Factors affecting the occurrence of hydrothorax in Egyptian patients with decompensated liver disease

It is well known that in cirrhotic patients, a large volume of ascetic fluid is generally well tolerated due to the capacitance of the peritoneal cavity. On the other hand, even modest volumes of pleural fluid can cause significant respiratory symptoms, including dyspnea and chest pain. Therefore, although infrequent, hepatic hydrothorax may represent a major clinical problem in the management of patients with portal hypertension. This work search for factors affecting the occurrence of hepatic hydrothorax in Egyptian patients with decompensated liver disease A total of 40 patients selected from Al Azhar University Hospitals with decompensated liver disease and ascites were included in this study divided into two groups 20 patients have ascites without pleural effusion were selected to be included in the study as a group [I], another a 20 patients have ascites with pleural effusion were selected also, to be included in the study as a group [II].All patients were subjected to the following:-Careful history taking, Careful clinical examination, laboratory investigations, including, complete urine and stool analysis, complete blood picture and, Liver function tests, Renal function tests, ascitic fluid and pleural fluid analysis for, physical, chemical, Cytological examinations. Abdominal Ultrasonography, Chest X ray, Results showed that the mean of BMI and ascitic fluid LDH are higher in patients with pleural effusion than in patients without pleural effusion. In contrast, the mean of alkaline phosphatase, ascitic fluid glucose and ascitic fluid RBCs are lower in patients with pleural effusion than in patients without pleural effusion but these findings are not enough to explain the occurrence of hepatic hydrothorax in those patients and these factors still obscure so more studies are needed to detect these factors