Management of inadvertent arterial catheterisation associated with central venous access procedures.
OBJECTIVE
This study aims to describe the clinical management of inadvertent arterial catheterisation after attempted central venous catheterisation.


METHODS
Patients referred for surgical or endovascular management for inadvertent arterial catheterisation during a 5-year period were identified from an endovascular database, providing prospective information on techniques and outcome. The corresponding patient records and radiographic reports were analysed retrospectively.


RESULTS
Eleven inadvertent arterial (four common carotid, six subclavian and one femoral) catheterisations had been carried out in 10 patients. Risk factors were obesity (n=2), short neck (n=1) and emergency procedure (n=4). All central venous access procedures but one had been made using external landmark techniques. The techniques used were stent-graft placement (n=6), percutaneous suture device (n=2), external compression after angiography (n=1), balloon occlusion and open repair (n=1) and open repair after failure of percutaneous suture device (n=1). There were no procedure-related complications within a median follow-up period of 16 months.


CONCLUSIONS
Inadvertent arterial catheterisation during central venous cannulation is associated with obesity, emergency puncture and lack of ultrasonic guidance and should be suspected on retrograde/pulsatile catheter flow or local haematoma. If arterial catheterisation is recognised, the catheter should be left in place and the patient be referred for percutaneous/endovascular or surgical management.
Department of Anesthesiology and Intensive Care Medicine, Lund University, Malmö University Hospital, Malmö, Sweden. andreas.pikwer@med.lu.se
A
A
Pikwer
S
S
Acosta
T
T
Kölbel
M
M
Malina
B
B
Sonesson
J
J
Akeson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000295:instrumentation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006489:Hemostatic Techniques / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011312:Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*