Strategies to Prevent Arterial Injury Caused by Dilator Should Be Integrated into Routine Clinical Practice

Endovascular repair of subclavian artery injury secondary to internal jugular vein catheterization: case report

“… 1 Alert patients also complain of chest pain 4 and tachypnea. 8 When these symptoms are observed during central venous catheterization, arterial injury must be suspected. However, patients under general anesthesia are asymptomatic, and several factors are associated with decreased blood pressure.…”

Massive hemothorax due to subclavian vein tear during internal jugular vein cannulation in a 15-year-old boy scheduled for mitral valve replacement

“…To prevent such an injury, it is advised that if any resistance is met, the guide-wire should be moved to and fro inside the dilator to check if it is freely mobile. [ 5 8 ] However, it may not always be possible to appreciate the meager resistance offered by the vessel wall. The vessel walls may have been delicate in this case as the patient had Marfan's syndrome.…”

“…The needle should not be passed deeper than the estimated depth to the clavicle. [ 8 ] One suggestion to avoid this would be to insert the needle at an angle of 60° or more to the skin in the coronal plane as opposed to the widely recommended 45°. This ensures that the vein is entered higher in the neck and at a smaller depth.…”