Stroke after internal jugular venous cannulation

Reuber, Markus; Dunkley, Liza; Turton, Philip; Bell, M. D. D.; Bamford, John

doi:10.1034/j.1600-0404.2002.1c222.x

Cited by 92 publications

(67 citation statements)

References 38 publications

(45 reference statements)

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“…Central venous access procedures are associated with inadvertent arterial puncture in upto 6% of patients when using external landmark technique. [5] This can subsequently lead to haemorrhage, pseudoaneurysm, AV fistula formation, arterial dissection, neurological injury and lethal airway obstruction. [6] Accidental arterial catheterization should be suspected immediately on excessive or pulsatile backflow of well oxygenated blood through the catheter or local hematoma at the site of catheterization.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic asymptomatic subclavian arteriovenous fistula after percutaneous catheterizationcutaneous catheterization

John¹,

Rajab²,

Ali³

et al. 2017

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A 4-year-old child with chronic enteropathy underwent left percutaneous internal jugular vein Hickman catheter insertion for total parenteral nutrition (TPN) under general anaesthesia. Previously this child had undergone percutaneous Hickman line insertion on the right internal jugular vein in 2013 and the right subclavian vein in 2015. These lines had been removed before due to catheter sepsis. During the present procedure, 6.6 french Hickman line was inserted into the left internal jugular vein by percutaneous peel away technique under ultrasound guidance. Later in the ward it was noticed that Hickman line was not functioning and there was reverse flow of blood into the intravenous (IV) line. Blood gas sample taken from the line showed arterial values and the catheter was subsequently removed. Computed tomography (CT) angiography was done which reported arteriovenous (AV) fistula with pseudoaneurysm of the right subclavian vein. The child was then referred to department of cardiothoracic surgery for further management. From the above case report we can infer that patients who underwent repeated percutaneous central line insertions may develop iatrogenic AV fistula or pseudo aneurysm. These complications can be asymptomatic for years. Failure to recognize this may lead to catastrophe during reinsertion. Hence proper history taking, clinical examination for bruit, thrill over the neck veins and cardiac examination should be done preoperatively if there is past history of multiple insertions. Investigations like venous blood gas sampling, USG doppler for neck veins, echocardiography, and CT angiography should be done in these cases preoperatively.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic asymptomatic subclavian arteriovenous fistula after percutaneous catheterizationcutaneous catheterization

John¹,

Rajab²,

Ali³

et al. 2017

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“…In several case reports, fatal outcome due to bleeding is most often considered a consequence of inadequate technique or management rather than bleeding diathesis [9,10]. The incidence of accidental arterial puncture is approximately 6% but can significantly be lowered by the use of ultrasound [11]. Even though complication rates in general are lower for the internal jugular vein access compared to other venous access routes, the risk for arterial puncture is higher [7,12].…”

Section: Case Reportmentioning

confidence: 99%

An Accidental Arterial Puncture and Anticoagulation after Internal Jugular Vein Catheterization Resulting in Massive Hematoma and Airway Compromise

Ruetzler¹,

Hauffe²,

Piegeler³

et al. 2018

Int J Anesthetic Anesthesiol

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Central Venous Catheterization is a common procedure in daily clinical practice. The internal jugular, subclavian and the femoral veins are the most frequently catheterized central veins. Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications. Nowadays, there are two techniques in daily clinical use: the traditional technique and the ultrasound guided technique.The traditional technique relies on the use of anatomical landmarks, but the failure rate is high-even in experienced hands. Furthermore, several different complications range from mechanical problems (5-19% of cases) to infections and thrombotic events (2-26%). There is compelling evidence that ultrasound-guided CVC insertion via the internal jugular veins is associated with higher success rates and fewer mechanical complications compared with the traditional techniques based on external anatomical landmarks.We report a clinical case of 76-years-old female patient requiring urgent placement of a central venous catheter and unrecognized arterial puncture and subsequent heparin overdose with nearly fatal outcome.eral venous access, administration of parenteral nutrition, vascular access in patients whose peripheral veins are difficult to catheterize, and procedures that require access to large-caliber vessels [1]. The central vessels that are most frequently catheterized are the internal jugular, subclavian, and femoral veins.The traditional CVC insertion technique relies on the use of anatomical landmarks rather than ultrasound guidance. But even in experienced hands, the traditional technique is associated with a high failure rate and several complications ranging from mechanical problems (5-19% of cases) to infections and thrombotic events (2-26%) [1][2][3][4].Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications [5]. The incidence of complications increase 6-fold after the third insertion attempt [1]. Other risk factors that are known to increase the incidence of complications are an inexperienced operator, the presence of anatomical variants as well as co-existing medical conditions such as clotting disorders, pulmonary emphysema, hypovolemia, or difficulties related to conditions under which the procedure is performed (i.e. an emergency) [5].

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“…The associated morbidities include punctured arteries for almost 10% of cases and haemothorax or pneumothorax for about 3% [1]. These complications can be serious or even fatal [2]. Although insertion of radial arterial and peripheral venous accesses is not associated with the same iatrogenic risks, it can cause pain and discomfort, delay care and, in the event of failure, deprive the patient of the best possible chances.…”

Section: Introductionmentioning

confidence: 96%