Iatrogenesis imperfecta: stroke caused by accidental carotid artery catheterization (original) (raw)
Related papers
Acta Medico-Biotechnica
Purpose: Insertion of a central venous catheter is a common procedure, performed by anesthesiologists and other medical professionals. The preferred site for central venous cannulation is the right internal jugular vein. Case Report: We present the case of a male patient who underwent renal transplantation for end-stage renal disease. During preparation for surgery, the right common carotid artery was cannulated instead of the right internal jugular vein. The situation was immediately recognized and managed by a vascular surgeon. The patient recovered completely without neurological deficit. Conclusion: Central venous cannulation is usually performed using the landmark technique. Incidental cannulation of the common carotid artery is a rare complication that can have serious consequences if not immediately recognized and properly managed.
Chinese Journal of Traumatology, 2019
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.
Hemodialysis International, 2011
Central venous catheterization is frequently performed for perioperative management and longterm intravenous access. Although complications associated with central venous catheter insertion have been widely reported, there are few reports of carotid-jugular arteriovenous fistula formation. Endovascular procedures are associated with a risk of immediate and delayed thromboembolic and ischemic complications. We describe a case of a carotid-jugular arteriovenous fistula and a cerebrovascular infarct following the insertion of a double-lumen catheter for hemodialysis access. We provide recommendations for the prevention and the early detection of this iatrogenic complication.
Inadvertent Arterial Trauma during Internal Jugular Vein Catheterization
To ensure safe placement of a central venous catheter (CVC), the potential accidents that may occur due to inadvertent arterial puncture through the internal jugular vein (IJV), should be carefully considered. Inadvertent common carotid arterial puncture during IJV catheterization is well recognized. However, other arteries including the subclavian, vertebral, transverse cervical and inferior thyroid arteries may be located behind the IJV, and are at risk of mispuncture. In the present study, we searched for case reports related to arterial trauma during IJV catheterization. In the present report, we describe information regarding CVC placement, including the historical and anatomical background, and the need for using ultrasonography during placement. Through our search, we obtained 9 cases of vertebral arterial, 7 cases of subclavian arterial, 1 case of thyrocervical trunk, 4 cases of transverse cervical arterial, and 1 case of inferior thyroid arterial insults that were caused in...
Vascular injury after arterial catheterization
Postgraduate Medical Journal, 1989
Twenty-three cases of arterial injury after 8,208 arterial catheterizations for diagnostic or therapeutic indications at Glasgow Royal Infirmary are reviewed. Clinical presentation included haematoma formation, development of an acutely ischaemic limb or a false aneurysm. Patients with valvular heart disease are identified as a high risk group. Nine cases were managed by simple suture of the puncture site whereas thrombectomy and vein patch closure was required in 12 patients. The incidence of late complications requiring vascular reconstruction was 9%. The early recognition ofcomplications after arterial catheterization and prompt referral to a specialized vascular unit is essential if morbidity is to be avoided.
Journal of Cardiothoracic Anesthesia, 1988
R EPORTED complications of percutaneous internal jugular vein cannulation include the rare occurrence of arteriovenous (A-V) fistulae.le8 A case is reported of a patient who developed a carotid artery-to-internal jugular vein (IJV) fistula, congestive heart failure (CHF), anemia, and a left pleural effusion after insertion of a pulmonary artery catheter introducer into the left IJV. CASE REPORT A 47-year-old woman was scheduled for aortic valve replacement for severe aortic stenosis. Location of both the right and left internal jugular veins proved to be difficult because the patient's neck was anatomically abnormal. The sternal heads of her clavicles and her sternal notch were located four to five centimeters lower than expected, at a level where her sternomanubrial junction should have been (Fig 1). Her sternocleidomastoid muscles were so well developed that her carotid pulses were not palpable on either side of her neck, and she was only able to turn her head 20 to 30 degrees to either side from the midline. An 18-gauge intravenous (IV) cannula was inserted at the medial border of the sternal belly of the right sternocleidomastoid muscle, at the level of the superior aspect of the thyroid cartilage, and was advanced laterally and caudally under the sternocleidomastoid muscle (Boulanger technique).' The carotid artery was punctured, bright red blood pumped out of the cannula, which was then removed; a hematoma resulted and pressure was applied to the neck. Using the same technique, an Is-gauge catheter was inserted under the left sternocleidomastoid muscle, and this time the left carotid artery was punctured. The needle was withdrawn and redirected half a centimeter more laterally, through the same puncture hole in the skin. The left IJV was then From the Departments of Anaesthesia and Cardiac Surgery, Montreal General Hospital.
Cureus
While central venous access is necessary for a variety of situations including inadequate peripheral venous access, medication administration, hemodynamic monitoring, vasopressor administration, and hemodialysis, complications during the insertion process are not uncommon. In the United States, in both critically ill medical patients and surgical patients, millions of central venous catheters are inserted yearly. Complications occurring during or immediately following insertion include cardiac, pulmonary, and vascular injuries as well as issues with catheter placement. This case report describes a rare malposition of the central venous cannula into the subclavian artery. Few case reports of accidental subclavian artery catheterization have been published following internal jugular vein insertion. While arterial puncture is a well-recognized complication, accidental subclavian artery catheterization is even rarer than carotid artery cannulation. In the literature review, only two documented case reports for reference were found. There are severe risks associated with arterial cannulation including atherosclerotic plaque dislodgement, stroke, hemothorax, pseudoaneurysm, arteriovenous fistula formation, and death. This case follows a 78-year-old man who was brought in by emergency medical services (EMS) minimally responsive with hemodynamic instability-hypothermic, hypotensive, and tachycardic. The emergent decision was made to proceed with central venous catheter placement in the emergency department and placement was initially confirmed with radiologic evidence. Over the admission course, the patient had improvement in hemodynamic instability with minimal change in mental status, however, the need for further testing revealed the central line that was previously functioning without difficulty was arterial. Imaging demonstrated catheter traversed the internal jugular vein and inserting into the right subclavian artery requiring emergent transfer for vascular and cardiothoracic surgery intervention. While a rare complication, this case, differing from previously documented reports due to the delay in discovery, exemplifies how further investigation may be warranted to confirm catheter placement prior to removal to reduce the risk of life-threatening situations.
Journal of Neuroendovascular Therapy, 2019
This study was conducted to clarify the characteristics of preprocedural vascular images in patients with acute embolic occlusion of the carotid artery in whom the internal carotid artery (ICA) could be recanalized by manual suction with syringe via the balloon guiding catheter (SS-BGC) alone. Methods: The subjects were 64 consecutive patients who underwent SS-BGC for carotid artery embolic occlusion at our institution between May 2006 and September 2017. The subjects were classified into those who with recanalization (R-SS-BGC group) and no recanalization (N-SS-BGC) of ICA by SS-BGC alone, and the background factors including findings of preprocedural vascular imaging and outcomes were compared between the two groups. Results: The R-SS-BGC and N-SS-BGC groups consisted of 16 and 48 patients, respectively. In the R-SS-BGC/N-SS-BGC groups, the horizontal segment of the ipsilateral anterior cerebral artery (A1) was patent in 15/24 (94/50%) and the horizontal segment of the ipsilateral middle cerebral artery (M1) was patent in 6/16 (38/34%) on preprocedural MRA. The ipsilateral posterior communicating artery (PcomA) was patent in 3/14 (19/29%) and the ipsilateral ophthalmic artery (OphA) was patent in 1/14 (6/29%) on preprocedural angiography. The median duration of operation was 39/86.5 minutes, and complete recanalization could be achieved in 15/34 (94/71%). The outcome was favorable in 10/11 (63/23%). Conclusion: In the R-SS-BGC group, the percentages of patients with patent ipsilateral A1 and M1 were high, and the percentages of those with patent ipsilateral PcomA and OphA were low.