[Blood reflux through the catheter when trying catheterization of the subclavian vein is not a reliable sign in case of hemothorax].
A 36-year-old man suffered chest and neurovascular trauma, soft-tissue injury to the left arm, and trauma to facial bones and extremities. He was hemodynamically unstable and responded poorly to blood transfusion and vasoactive medication. Pneumothorax was suspected. When a tube was inserted into the left hemithorax, 1500 mL of blood was drained. A chest film revealed hemothorax and a contusion on the left lung, but no rib fractures. An attempt to catheterize the left subclavian vein yielded reflux, and blood was then transfused. The patient continued to be highly unstable and an additional 1000 mL of blood was drained. Exploratory thoracotomy revealed a ruptured subclavian vein, location of the venous catheter in the pleural cavity, and a fracture of the first left rib. After chest injury leading to hemothorax, reflux upon catheterization of the ipsilateral subclavian vein is not a sure sign of correct tip placement. Additional means for checking placement, such as assessing pressure wave morphology, should be used. A fracture of the first rib, which may not be evident on a chest x-ray, often causes a vascular lesion and thoracic hemorrhage. Incorrect insertion of a subclavian catheter may then follow.
del Castillo Fernández
de Betoño T
de BT
Hospital Virgen de la Torre, Madrid.
Pulido Oleaga
C
C
Gago
S
S
Zaballos
M
M
Garutti
I
I
de Lucas
E García
EG
D000328:Adult; D002405:Catheterization, Central Venous; D006491:Hemothorax / Q000175:diagnosis*; D006801:Humans; D008297:Male; D012039:Regional Blood Flow; D013350:Subclavian Vein