Central Venous Cannulation Case Study
Introduction
Central venous cannulation is a routine procedure, which is safe in experienced hands, especially under ultrasound guidance. Central venous cannulation is associated with various complications, some being potentially dangerous like inadvertent arterial puncture.
We hereby report a case of inadvertent cannulation of left subclavian artery during ultrasound guided placement of central venous catheter in left internal jugular vein(IJV).
Case Report
A 46-year-old female with no co-morbidities presented with cough and breathlessness on day 2 of second cycle of chemotherapy. She had undergone modified radical mastectomy a year ago.
An echocardiogram showed an ejection fraction of 20-25 %, with dilated left ventricle and diastolic dysfunction. …show more content…
The procedure was uneventful.
Following this the patient received drugs including inotropes through the newly inserted left IJV catheter. While checking central venous pressure of the patient, after attaching pressure transducer an arterial waveform was noticed. The blood from the central line was sent for gas analysis which confirmed an arterial cannulation. Chest X ray was reassessed and the tip of catheter was found to be straight and not crossing midline as shown in the …show more content…
For removal of a catheter and external compression the artery should be easily accessible and compressible, e.g. femoral artery. Subclavian artery lies below the clavicle and is inaccessible. Carotid artery compression involves risk of cerebral ischaemia, dislodgement of embolus. Guilbert et al [7] concluded that pull and pressure method has highest number of complications and recommend surgical arterial repair. They also proposed a Guilbert management algorithm [7] suggesting that if the site of repair is easily accessible like carotid artery surgical repair should be done while, in subclavian artery endovascular repair is preferred. The use of endovascular techniques varies as per the patient factors, coagulation status and site of vessel punctured. Two types of endovascular devices are, stent grafts and percutaneous vascular closure device. Two types of closure devices available are suture based and collagen based. Collagen based devices are currently licensed for femoral arterial puncture and have been successfully used even in subclavian arterial
Central venous cannulation is a routine procedure, which is safe in experienced hands, especially under ultrasound guidance. Central venous cannulation is associated with various complications, some being potentially dangerous like inadvertent arterial puncture.
We hereby report a case of inadvertent cannulation of left subclavian artery during ultrasound guided placement of central venous catheter in left internal jugular vein(IJV).
Case Report
A 46-year-old female with no co-morbidities presented with cough and breathlessness on day 2 of second cycle of chemotherapy. She had undergone modified radical mastectomy a year ago.
An echocardiogram showed an ejection fraction of 20-25 %, with dilated left ventricle and diastolic dysfunction. …show more content…
The procedure was uneventful.
Following this the patient received drugs including inotropes through the newly inserted left IJV catheter. While checking central venous pressure of the patient, after attaching pressure transducer an arterial waveform was noticed. The blood from the central line was sent for gas analysis which confirmed an arterial cannulation. Chest X ray was reassessed and the tip of catheter was found to be straight and not crossing midline as shown in the …show more content…
For removal of a catheter and external compression the artery should be easily accessible and compressible, e.g. femoral artery. Subclavian artery lies below the clavicle and is inaccessible. Carotid artery compression involves risk of cerebral ischaemia, dislodgement of embolus. Guilbert et al [7] concluded that pull and pressure method has highest number of complications and recommend surgical arterial repair. They also proposed a Guilbert management algorithm [7] suggesting that if the site of repair is easily accessible like carotid artery surgical repair should be done while, in subclavian artery endovascular repair is preferred. The use of endovascular techniques varies as per the patient factors, coagulation status and site of vessel punctured. Two types of endovascular devices are, stent grafts and percutaneous vascular closure device. Two types of closure devices available are suture based and collagen based. Collagen based devices are currently licensed for femoral arterial puncture and have been successfully used even in subclavian arterial