An unusual complication following central venous catheter placement
Abstract
Abstract : A 38 year old female, diagnosed with rheumatic
mitral stenosis was posted for an elective mitral valve
replacement surgery. In the operating room, prior to induction
of anaesthesia, central venous cannulation of the right
internal jugular vein was performed by the central approach
using Seldingers technique. In spite of the free venous blood
flow on aspiration, the guide wire failed to advance beyond 10
cm in two attempts. Following this, guide wire was introduced
with the opposite straight end first, which passed freely, and
catheter was inserted. On check aspiration, there was free
flow of blood from all three lumens, CVP trace was present
and initial CVP read 7 cm H2O. The patient vitals were stable.
No check X-ray was obtained. Attempts to induce the patient
into anaesthesia by administering drugs through the central
venous line failed, following which the catheter was suspected
to be defunct. Intra operatively, the surgeons traced the
catheter tip which was found to have punctured the right
internal jugular vein, right subclavian artery and the right side
pleura on its course into the right intrapleural space.
Keyword :Central venous cannulation, J-tip, guide wire,
central venous catheter insertion complications, malposition,
internal jugular vein
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