title: Arterial misplacement of a femoral central venous catheter complicated with acute arterial occlusion.
abstract: Femoral vein catheterization is often carried out during resuscitation and in critical care units. It is usually achieved via a blind, external landmark-guided technique, through manual localization of the femoral artery. However, this approach can be challenging in patients with severe shock because of absence or ambiguity of the arterial pulse. We report a case of inadvertent cannulation, with a large-bore catheter, of the right femoral artery, which was mistaken as a venous route for medication and massive transfusion. The large cannula caused direct mechanical obstruction, while intra-arterial medications induced vascular injury and vasospasm. Both factors led to thrombosis and occlusion of the right external iliac artery, thus jeopardizing the distal blood supply, and ultimately resulting in muscle necrosis of the involved limb, and the need for thrombectomy and extensive fasciotomy to salvage the extremity. This case highlights that correct placement of a central venous catheter should be clearly ascertained before the catheter is used for medical treatment, especially when catheterization is performed in shock status.
authors.affiliation: Department of Anesthesiology, Far-Eastern Memorial Hospital, Panchiao, Taipei, R.O.C. hung9753@yahoo.com.tw
authors.forename: Hung-Lung
authors.initials: HL
authors.lastname: Hung
authors.forename: Kuo-Yung
authors.initials: KY
authors.lastname: Chao
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Tseng
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Hung
authors.forename: Tak-Yu
authors.initials: TY
authors.lastname: Lee
mesh_terms: D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D005268:Femoral Vein; D006801:Humans; D007083:Iliac Artery; D008875:Middle Aged; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery