Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm

Abstract

During central venous placement, prevention of arterial puncture and cannulation is essential to minimize serious sequelae. If arterial trauma with a large-caliber catheter occurs, prompt surgical or endovascular treatment seems to be the safest approach. The pull/pressure technique is associated with a significant risk of hematoma, airway obstruction, stroke, and false aneurysm. Endovascular treatment appears to be safe for the management of arterial injuries that are difficult to expose surgically, such as those below or behind the clavicle. After arterial repair, prompt neurological evaluation should be performed, even if it requires postponing elective intervention. Imaging is suggested to exclude arterial complications, especially if arterial trauma site was not examined and repaired.

Central venous catheter misplaced in the vertebral artery

“…Pulling large bore catheters and the application of pressure without angiographic or direct visualization is associated with major complications in 30 % to 47 % of patients. Compared to surgical exploration, catheter removal and artery repair is safer, and this approach is strongly recommended [9,10]. In a recent series of six patients, repair of carotid puncture sites with a suture-mediated closure device has also been shown to be safe and eff ective [11].…”

The wire is really easy to see (WIRES): sonographic visualization of the guidewire by novices

“…Although uncommon, inadvertent carotid artery cannulation can cause bleeding, airway compromise, stroke, or death. [5][6][7][8] An ideal technique for avoiding this iatrogenic error would be reliable, easy to learn, and inexpensive and cause little procedural disruption. One suggested technique for confirming proper vessel entry involves attaching plastic intravenous tubing to the needle after vessel penetration and observing the flow and pulsation of blood within the tubing with positional changes.…”

“…4,5 The incidence of this complication is thought to be low but is likely underreported. 6 Complications that may occur as a result of iatrogenic carotid artery cannulation include airway compromise from expanding hematomas or pseudoaneurysms, hemothorax, carotid-jugular fistula, stroke, and death. [5][6][7][8] One proposed method for avoiding carotid artery cannulation is to visualize the guidewire sonographically ( Figure 1) prior to dilation and placement of the catheter.…”

“…6 Complications that may occur as a result of iatrogenic carotid artery cannulation include airway compromise from expanding hematomas or pseudoaneurysms, hemothorax, carotid-jugular fistula, stroke, and death. [5][6][7][8] One proposed method for avoiding carotid artery cannulation is to visualize the guidewire sonographically ( Figure 1) prior to dilation and placement of the catheter. [9][10][11] Previous studies have demonstrated that the guidewire is easier to visualize than the needle and that physicians with fellowship training in ultrasonography can determine guidewire positioning with 100% accuracy.…”

Spontaneous Resolution of Delayed Onset Large Subclavian Artery Pseudoaneurysm -Case Report-

“…4) Arterial trauma caused by a large-bore dilator or catheter is usually associated with serious complications and requires prompt surgical or endovascular treatment. 6) Coil placement into a pseudoaneurysm in the acute phase can be dangerous because of the absence of a true aneurysm wall. Therefore, endovascular occlusion of the parent vessel is often the most effective treatment if possible.…”