Late atrial perforation from tunnelled haemodialysis catheter

Central venous cannulation is a commonly performed procedure in HD patients. One complication associated with such a procedure includes cardiac tamponade, thought to arise from the guidewire, dilator or venous cannula piercing the myocardial wall. This particular risk may be minimized by the use of soft j-tipped wires, ensuring cannulae are not advanced too far or against resistance and the use of post-procedure chest radiographs to confirm correct catheter positioning. Most such complications, however, occur at the time of insertion. We report here a rare case of a soft silicone HD catheter migration 2 years following insertion.