title: Repeated neurological complications during dialysis - a case for echo?
abstract: A 65-year old woman presented with acute or chronic renal failure and signs of right heart failure. Renal replacement therapy—using a surgically placed dialysis catheter via the left jugular vein—was repeatedly complicated by altered flows of the dialysis unit, impaired consciousness, new onset of seizures and left-sided hemiparesis. The tip of the dialysis catheter was detected on transesophageal echocardiography within the lumen of the ascending aorta. Further imaging of the neck vessels demonstrated a primary placement of the catheter in the left common carotid artery. This incident underscores the value of ultrasound guidance for placement of intravascular catheters.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany; Departments of Anesthesiology, University of Virginia, Charlottesville, Virginia.
authors.forename: Danja S
authors.initials: DS
authors.lastname: Groves
authors.forename: Ulf
authors.initials: U
authors.lastname: Harding
authors.forename: Christian
authors.initials: C
authors.lastname: Lanckohr
authors.forename: Antje
authors.initials: A
authors.lastname: Gottschalk
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000517:prevention & control; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000517:prevention & control; D006435:Renal Dialysis / Q000009:adverse effects*
keywords: TEE; carotid artery; echocardiography; iatrogenic; mobile components; transient ischemic attack (TIA)