CHEST Guidelines-Potassium-Chloride-Infused-in-the-Left-Internal-Ma

Potassium-Chloride-Infused-in-the-Left-Internal-Ma

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The document includes a correspondence in response to a previously published article in the journal CHEST, June 2023, entitled “Potassium Chloride Induced Phlebitis via a Malpositioned Central Venous Catheter.” Dr. Frank A. Baciewicz Jr. addresses an alternative explanation to the chest discomfort post potassium chloride infusion chronicled in the article. Baciewicz proposes that the discomfort might be due to infusion through a small diameter left internal mammary vein rather than the accessory hemiazygos vein, which is the scenario described in the original article.<br /><br />He notes that during procedures like harvesting the left internal mammary artery (LIMA) for coronary artery bypass, it is possible for a catheter to malposition into the left internal mammary vein. The suggestion is based on his surgical observations where the catheter can sometimes end up in the left internal mammary vein, not typically ligated, which could cause discomfort with an infusion.<br /><br />Authors of the original article responded by showing appreciation for Baciewicz's insights and admitting the limitations of their diagnosis due to a lack of extended imaging beyond an initial chest radiograph. They acknowledge the plausibility of Baciewicz’s suggestion, adding that the exact location of the malpositioned catheter in their report could not be confirmed without those additional diagnostics. The response indicates that while the possibility of catheter malpositioning into the left internal mammary vein exists, as Baciewicz mentioned, without further imaging, confirming the precise location remained unresolved.

Keywords

Potassium Chloride

Phlebitis

Central Venous Catheter

Chest Discomfort

Left Internal Mammary Vein

Coronary Artery Bypass

Catheter Malposition

Journal CHEST

Imaging Limitations

Baciewicz