Inadvertent Puncture of the Thoracic Duct During Attempted Central Venous Catheter Placement (original) (raw)

Accidental Central Venous Catheter Placement in the Internal Thoracic Vein: A Case Report

Cureus, 2020

Central venous catheter (CVC) placement is an essential component of critical care medicine. CVC malposition is a known complication of internal jugular vein (IJV) cannulation. However, catheterization of the internal thoracic vein (ITV) is much rarer. Only a handful of case reports have been documented, and guidelines for management are therefore lacking. Our case study describes this rarely occurring ITV cannulation along with the discussion of risk factors, warning signs of malpositioning, and subsequent management plans to optimize patient safety. Previous studies have used fluoroscopy and agitated saline flush tests to confirm that agents administered through an ITV-located catheter would reach the right atrium. Considering this, it would follow that a catheter in this site could theoretically be used for medication administration, especially in emergency settings. This hypothesis remains the most novel part of our case study and might prompt further exploration of management strategies in this particular situation.

A Devastating Complication of Central Venous Catheter Insertion

Journal of acute medicine, 2019

Retained guidewire is a major complication of central line placement. We present a patient with infective endocarditis caused by a retained guidewire. A young man admitted to our emergency department complained of debilitating weakness, productive cough, and fever for seven days. Chest radiography showed some lesions in both lungs as well as a retained guidewire. Past history revealed a thermal burn injury one month before, during which an internal jugular central venous line was inserted. Echocardiography showed multiple large vegetations in right atrium and right ventricle. Thus, infective endocarditis and multiple embolic lung lesions were treated with empirical antibiotics. Guidewire was removed by vascular surgery service. Unfortunately, the patient died before undergoing open-heart surgical intervention. It is believed that central vein catheterization requires special attention to perform through the Seldinger technique skillfully and under supervision to avoid preventable co...

Management of an Unusual Complication During Placement of a Pulmonary Artery Catheter

Anesthesia & Analgesia, 2004

We describe an unusual complication during flotation of a pulmonary artery catheter through a preexisting percutaneous introducer sheath. A malfunctioning pulmonary artery catheter, which was placed through an introducer sheath in the right internal jugular vein, was removed. Attempts at repositioning a second pulmonary artery catheter met with resistance, and we were unable to either advance or withdraw it. Chest radiograph showed a bent introducer sheath going from the right internal jugular vein into the right subclavian vein and a pulmonary artery catheter loop. Under continuous fluoroscopy, the introducer sheath and the pulmonary artery catheter were withdrawn as one unit, which resulted in relaxation of the acute angulation in the introducer sheath and allowed the pulmonary artery catheter to unfold, thus facilitating their complete extraction. We conclude that complications may occur during placement of a pulmonary artery catheter through a well positioned introducer sheath and that fluoroscopy is a valuable tool for safe management of such a complication.

Malposition of Subclavian Venous Catheter Leading to Chest Complications

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2016

Although Central Venous Catheter (CVC) placement is a relatively simple procedure but its insertion and maintenance are associated with significant risks. Malposition (defined as any CVC tip position outside the superior vena cava) may be associated with catheter insertion and may require immediate intervention. It may result in complications like haemothorax, pleural effusions, pneumothorax, sepsis, thrombosis and cardiac tamponade. This case report presents timely detection of the complication after placement of CVC. Everyone should be aware of the complications and monitor consistently appropriate position of catheter tips. [Table/Fig-1]: Chest X-ray showing right sided haemothorax and abnormally placed catheter. [Table/Fig-2]: Chest X-ray showing opaque right lung along with chest tube and abnormal position of the central line catheter. DISCUSSION Central Venous Catheterization (CVC) is a time honored, safe and commonly performed invasive procedure in intensive care units and also in all specialties ranging from oncology, anesthesia, to emergency medicine [1-4]. It plays an indispensable role in the www.jcdr.net

A patient with an uncommon complication from insertion of a central venous catheter: A case report

Cases Journal, 2008

Background: A 72 year old male was admitted to the medical intensive care unit with septic shock. Case presentation: A left subclavian central venous catheter was inserted on the day of admission whose tip was pushing against the wall of the vessel lumen. The patient's condition improved with treatment, but three days later had a new episode of acute hypotension. CT scan of the chest showed that the catheter had eroded through the superior vena cava wall. Conclusion: The catheter was pulled out and patient recovered from the complication with supportive therapy. Care should be taken that the tip of the catheter is in the center of the vessel lumen to avoid this rare, but potentially life threatening, complication.

Accidental Superior Vena Cava Access to Central Venous System Lately Disclosed by Thoracotomy

Annals of Vascular Surgery, 2014

We report the case of a 51-year-old woman who underwent hemicolectomy for colon cancer and subsequent hepatic metastasectomy for liver metastases. Right percutaneous infraclavicular subclavian venous port catheterization was performed during the initial operation for chemotherapy. She received chemotherapy after each operation with no reported complications. During a right thoracotomy for lung metastases 2 years after the catheter placement, we noticed the catheter perforating the right subclavian vein and directly entering the superior vena cava. To prevent hemorrhaging during catheter removal, we initially performed the lung metastasectomy, after which we decided to intrathoracically remove the catheter. No complication was observed. To the best of our knowledge, this case is the first of its kind to be reported in the published literature. Fig. 2. Intraoperative view of the catheter perforating the right subclavian vein and entering the superior vena cava.

Complication of Central Venous Catheterisation: Breakage of guidewire-a disaster averted.

Central venous catheterisation (CVC) is a common bedside invasive procedure done in medical practice. Even though it is a safe procedure when done with ultrasound guidance, difficulties and complications do occur even in experienced hands. Here, we describe the difficulties encountered in the form of the breakage of the guidewire while inserting a CVC in a patient with sickle cell disease.