J Korean Med Sci.  2012 Oct;27(10):1265-1268. 10.3346/jkms.2012.27.10.1265.

Unintended Cannulation of the Subclavian Artery in a 65-Year-Old-Female for Temporary Hemodialysis Vascular Access: Management and Prevention

• Choi JI
• Cho SG
• Yi JH
• Han SW
• Kim HJ

• KMID: 1778837
• DOI: http://doi.org/10.3346/jkms.2012.27.10.1265

Abstract

Ultrasound-guided cannulation of a large-bore catheter into the internal jugular vein was performed to provide temporary hemodialysis vascular access for uremia in a 65-yr-old woman with acute renal failure and sepsis superimposed on chronic renal failure. Despite the absence of any clinical evidence such as bleeding or hematoma during the procedure, a chest x-ray and computed tomographic angiogram of the neck showed that the catheter had inadvertently been inserted into the subclavian artery. Without immediately removing the catheter and applying manual external compression, the arterial misplacement of the hemodialysis catheter was successfully managed by open surgical repair. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization with a large-bore catheter and to the management of its potentially devastating complications, since central vein catheterization is frequently performed by nephrologists as a common clinical procedure to provide temporary hemodialysis vascular access.

Keyword

Hemodialysis; Complication; Central Venous Catheterization

MeSH Terms

Acidosis/complications
Acute Disease
Aged
Catheterization, Central Venous/*adverse effects
Female
Hemorrhage/etiology
Humans
Kidney Failure, Chronic/*diagnosis
Medical Errors/*prevention & control
Oliguria/complications
Renal Dialysis
Sepsis/etiology
Subclavian Artery/injuries/*radiography/surgery
Tomography, X-Ray Computed
Uremia/etiology

Figure

• 

  Fig. 1 Chest X-ray following central vein cannulation for a temporary hemodialysis vascular access via the right internal jugular vein showing that the catheter might have been misplaced in the right subclavian artery (arrows).

• 

  Fig. 2 Three-dimensional reconstruction of computed tomographic angiography of the neck through the inadvertently inserted catheter confirming that it (white arrow) had penetrated the vessel wall of the right internal jugular vein (blue arrow) and had been inserted into the right subclavian artery (red arrow).

• 

  Fig. 3 Angiogram following open surgical repair showing absence of visible bleeding and of any arterio-venous fistula of the right subclavian artery (arrows).

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