Michiel B Winkes1, Maarten J Loos1, Marc R Scheltinga1,2, Joep A Teijink2,3. 1. Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands. 2. CARIM Research School, Maastricht University, Maastricht - The Netherlands. 3. Cardiovascular Center, Catharina Hospital, Eindhoven - The Netherlands.
Abstract
PURPOSE: We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion. METHOD AND RESULTS: An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation. The patient underwent a sternotomy, the lines were removed and the venous laceration was closed. The patient recovered well. CONCLUSIONS: In spite of ultrasound guidance, fluoroscopy for guidewire and sheath advancement, venous blood aspiration and a normal appearing postoperative x-ray, traumatic central venous catheter placement is still possible. Tenting of the BCV wall during catheter advancement possibly caused the venous perforation. A 'how-to' for correct catheter placement via the IJV is provided and potential pitfalls during each procedural step are discussed.
PURPOSE: We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion. METHOD AND RESULTS: An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation. The patient underwent a sternotomy, the lines were removed and the venous laceration was closed. The patient recovered well. CONCLUSIONS: In spite of ultrasound guidance, fluoroscopy for guidewire and sheath advancement, venous blood aspiration and a normal appearing postoperative x-ray, traumatic central venous catheter placement is still possible. Tenting of the BCV wall during catheter advancement possibly caused the venous perforation. A 'how-to' for correct catheter placement via the IJV is provided and potential pitfalls during each procedural step are discussed.