Improperly placed Drainage Catheter in a Patient who developed ARDS due to H1N1 Pneumonia, and increased Intra-Abdominal Pressure Mimicking Signs of Hypovolemia

Abdulkadir Yektas

Abstract

ECMO is a technique that involves oxygenation of blood and removal of carbon dioxide using extra-corporeal circulation through an oxygenator and a magnetic pump. In V-V ECMO, drainage catheter is placed at the junction of the inferior vena cava and the right atrium or nearby, and the catheter that allows re-circulation to the patient is placed at the junction of the superior vena cava and the right atrium or into the right atrium. Having been followed up for H1N1 and referred to our hospital, a patient developing ARDS was performed femoro-jugular V-V ECMO to rest the lungs but the drainage cannula was placed distant from the junction of the inferior vena cava and the right atrium, which resulted in abdominal compartment syndrome due to volume loading. Increased intraabdominal pressure pressed the vena cava inferior, which prevented the drainage catheter from draining the blood. ECMO failed to read the blood flow and thrill was detected in the drainage catheter. All these findings suggested hypovolemia. This case report intends to present the vicious cycle that developed as a result of the collapse of the vena cava inferior due to increased intra-abdominal pressure caused by improper placement of the drainage catheter and by volume loading, which finally renders the drainage catheter unable to drain adequate volume of blood.