Arterial Placement of Central Venous Catheters

Abstract

Arterial misplacement of central venous catheters can often be avoided with the use of real-time ultrasound-guided procedural competency. However, misplacement can still occur and is more likely to occur when the internal jugular vein is located directly above the common carotid injury. The resultant injury to the common carotid artery occurs through the posterior wall of the internal jugular vein. Arterial injury may also occur when the subclavian vein is attempted in a non-ultrasound-guided fashion. Optimal management requires a coordinated evaluation of the catheter misplacement by Interventional Radiology and Vascular Surgery to ensure maximum patient safety during catheter removal. This article reviews the literature around this topic and provides a summary of the best approach to safely remove the misplaced catheter. Resume Le mauvais positionnement artériel des cathéters veineux centraux peut souvent être évité grâce à l'utilisation de compétences procédurales guidées par ultrasons en temps réel. Cependant, un mauvais positionnement peut toujours se produire et est plus susceptible de se produire lorsque la veine jugulaire interne est située directement au-dessus de la lésion carotidienne commune. La lésion de l'artère carotide commune qui en résulte se produit à travers la paroi postérieure de la veine jugulaire interne. Une lésion artérielle peut également se produire lorsque la veine sous-clavière n'est pas guidée par un ultrason. Une gestion optimale nécessite une évaluation coordonnée du mauvais positionnement du cathéter par la radiologie interventionnelle et la chirurgie vasculaire afin de garantir une sécurité maximale au patient lors du retrait du cathéter. Cet article passe en revue la littérature sur ce sujet et fournit un résumé de la meilleure approche pour retirer en toute sécurité le cathéter mal placé.

Inadvertent fatal carotid artery laceration at the time of jugular venipuncture in a healthy cat

“…With small lesions from arterial needle puncture, immediate manual compression with close monitoring may be recommended 18 . However, for larger lesions, especially in cases of accidental catheterization of the carotid, options include an open approach to repair the vessel, endovascular closure with a covered stent and ligation of the vessel, which is a considered a salvage procedure 19–20 . In humans, carotid artery ligation is reserved for patients that are haemodynamically unstable or in cases where the artery is not easily accessible, as ligation carries a greater risk of death, stroke and neurologic deficits 21 .…”

“…18 However, for larger lesions, especially in cases of accidental catheterization of the carotid, options include an open approach to repair the vessel, endovascular closure with a covered stent and ligation of the vessel, which is a considered a salvage procedure. [19][20] In humans, carotid artery ligation is reserved for patients that are haemodynamically unstable or in cases where the artery is not easily accessible, as ligation carries a greater risk of death, stroke and neurologic deficits. 21 Due to their extensive collateral vasculature, dogs may have a lower risk of these events occurring after ligation of the carotid, [22][23] and the procedure has been described in dogs for treatment of intractable epistaxis as well as haemorrhage during maxillofacial surgery.…”

Ministernotomy repair of inadvertent proximal right subclavian artery injury following right internal jugular central venous catheter insertion

“…The risk of arterial injury following central venous catheter placements is less than 1% 2. Commonly injured arteries include carotid, subclavian, brachiocephalic, vertebral arteries and the aorta.…”