Management of inadvertent carotid artery sheath insertion during central venous catheter placement.
OBJECTIVE
Inadvertent carotid sheath insertion during central venous catheter placement could lead to serious complications.


OBJECTIVE
To describe management of inadvertent carotid artery sheath insertion placed intraoperatively during attempted jugular venous cannulation for pulmonary artery catheter placement.


METHODS
In a retrospective medical record review of patients from hospitals affiliated with Baylor College of Medicine, Houston, Texas, a total of 12 patients over 11 years who sustained intraoperative carotid artery introducer sheath placement during attempted jugular vein cannulation were identified. Six patients underwent immediate carotid artery exploration with sheath removal and primary repair. The remaining 6 patients underwent percutaneous closure using a suture-mediated closure device. Treatment outcomes of these 2 groups were analyzed.


METHODS
Technical success, duration of treatment, stroke, return to the operating room, and long-term outcomes.


RESULTS
Technical success was achieved in all patients in both groups. The intended operations were aborted in all patients following catheter removal and carotid artery closure. The mean (SD) durations of treatment for the operative and endovascular groups were 32 (12) minutes and 6 (3) minutes, respectively (P = .03). No neurological deficit occurred in either group. The intended operations were all subsequently performed, and the mean delays of operation in the operative and endovascular groups were 5 and 3 days, respectively (P = .20). Follow-up carotid duplex showed no injury of the repaired artery in either group. During a mean follow-up of 42 months, no complications or neurological deficits were noted in either patient cohort.


CONCLUSIONS
Inadvertent carotid artery sheath placement during attempted central venous cannulation for pulmonary artery catheter insertion mandates catheter removal and repair of the carotid artery puncture site. The closure device permits percutaneous repair of the carotid artery expeditiously. Our experience showed this treatment modality to be as safe and effective as operative repair.
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey VA Medical Center, Houston, Texas.
Carlos F
CF
Bechara
Neal R
NR
Barshes
George
G
Pisimisis
Panos
P
Kougias
Peter H
PH
Lin
D017130:Angioplasty; D020212:Carotid Artery Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D020878:Device Removal; D006801:Humans; D007049:Iatrogenic Disease; D007601:Jugular Veins; D019300:Medical Errors / Q000009:adverse effects*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome