Needle loss in subclavian vein during central venous catheter placement: case report of a rare complication

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• 作者：Daniela Botolin (1)
  Annie Mooser (2)
  Duane Stillions (3)
  Keith Mortman (4)
  Shawn Sarin (5)
  Joseph Babrowicz (6)
  
  1. Department of Surgery ; The George Washington University Hospital ; 2150 Pennsylvania Avenue ; NW ; Suite 6B ; Washington ; DC ; 20037 ; USA
  2. Division of General Surgery ; Walter Reed National Military Medical Center ; 8901 Rockville Pike ; Arrowhead Building ; 1st Floor ; Bethesda ; MD ; 20889 ; USA
  3. Department of Anesthesiology and Critical Care Medicine ; The George Washington University Hospital ; 900 23rd Street ; NW ; Washington ; DC ; 20037 ; USA
  4. Division of Thoracic Surgery ; The George Washington University Hospital ; Foggy Bottom South Pavilion ; 22nd & I Street ; NW ; 6th Floor ; Washington ; DC ; 20037 ; USA
  5. Department of Radiology ; The George Washington University Hospital ; 900 23rd Street ; NW ; Washington ; DC ; 20037 ; USA
  6. Division of Vascular Surgery ; The George Washington University Hospital ; Foggy Bottom South Pavilion ; 22nd & I Street ; NW ; 6th Floor ; Washington ; DC ; 20037 ; USA
  
• 关键词：Subclavian ; Catheter ; Fluoroscopy ; Ultrasound ; Obesity
• 刊名：Patient Safety in Surgery
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：9
• 期：1
• 全文大小：1,175 KB
• 参考文献：1. Seldinger, SI (1953) Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiologica 39: pp. 368-376 CrossRef
  2. Raad, I (1998) Intravascular-catheter-related infections. Lancet 351: pp. 893-898 40-6736(97)10006-X" target="_blank" title="It opens in new window">CrossRef
  3. Casanova Vivas, S (2014) Recommendations from CDC for the prevention of catheter-related infections (2013 update). Revista de enfermeria (Barcelona, Spain) 37: pp. 28-33
  4. McGee, DC, Gould, MK (2003) Preventing complications of central venous catheterization. New Eng J Med 348: pp. 1123-1133 CrossRef
  5. Mansfield, DC, Zeki, SM, Mackenzie, JR (1994) Case report: extravasation of lipiodol鈥揳 complication of dacryocystography. Clin Radiol 49: pp. 217-218 CrossRef
  6. Randolph, AG, Cook, DJ, Gonzales, CA, Pribble, CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24: pp. 2053-2058 46-199612000-00020" target="_blank" title="It opens in new window">CrossRef
  7. Eisen, LA, Narasimhan, M, Berger, JS, Mayo, PH, Rosen, MJ, Schneider, RF (2006) Mechanical complications of central venous catheters. J Intensive Care Med 21: pp. 40-46 4" target="_blank" title="It opens in new window">CrossRef
  8. Schummer, W, Schummer, C, Gaser, E, Bartunek, R (2002) Loss of the guide wire: mishap or blunder?. British J Anaesth 88: pp. 144-146 44" target="_blank" title="It opens in new window">CrossRef
  9. Fragou, M, Gravvanis, A, Dimitriou, V, Papalois, A, Kouraklis, G, Karabinis, A, Saranteas, T, Poularas, J, Papanikolaou, J, Davlouros, P, Labropoulos, N, Karakitsos, D (2011) Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med 39: pp. 1607-1612 CrossRef
  
• 刊物主题：Surgery;
• 出版者：BioMed Central
• ISSN：1754-9493

文摘

We present a case of needle separation during central venous catheter (CVC) placement in a super morbidly obese patient with subsequent surgical intervention in its retrieval. This complication, potentially lethal due to the relevant anatomy of such a procedure, alerts critical care physicians and surgeons to the possibility of equipment failure and stresses proper technique in what has become a routine procedure. It also emphasizes the routine use of ultrasound-guidance for cannulation in patients of any body habitus. While infection and arrhythmia are the generally known complications of CVC placement, clinicians must be alert to unanticipated events such as needle separation. In our case, the retrieval of this needle required multi-disciplinary intervention between radiology, critical care, vascular surgery, and thoracic surgery. Our event stresses hypervigilance to complications in a common procedure.