title: Needle loss in subclavian vein during central venous catheter placement: case report of a rare complication.
abstract: We present a case of needle separation during central venous catheter (CVC) placement in a super morbidly obese patient with subsequent surgical intervention in its retrieval. This complication, potentially lethal due to the relevant anatomy of such a procedure, alerts critical care physicians and surgeons to the possibility of equipment failure and stresses proper technique in what has become a routine procedure. It also emphasizes the routine use of ultrasound-guidance for cannulation in patients of any body habitus. While infection and arrhythmia are the generally known complications of CVC placement, clinicians must be alert to unanticipated events such as needle separation. In our case, the retrieval of this needle required multi-disciplinary intervention between radiology, critical care, vascular surgery, and thoracic surgery. Our event stresses hypervigilance to complications in a common procedure.
authors.affiliation: Department of Surgery, The George Washington University Hospital, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC 20037 USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Botolin
authors.affiliation: Division of General Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Arrowhead Building, 1st Floor, Bethesda, MD 20889 USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Mooser
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The George Washington University Hospital, 900 23rd Street, NW, Washington, DC 20037 USA.
authors.forename: Duane
authors.initials: D
authors.lastname: Stillions
authors.affiliation: Division of Thoracic Surgery, The George Washington University Hospital, Foggy Bottom South Pavilion, 22nd & I Street, NW, 6th Floor, Washington, DC 20037 USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Mortman
authors.affiliation: Department of Radiology, The George Washington University Hospital, 900 23rd Street, NW, Washington, DC 20037 USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Sarin
authors.affiliation: Division of Vascular Surgery, The George Washington University Hospital, Foggy Bottom South Pavilion, 22nd & I Street, NW, 6th Floor, Washington, DC 20037 USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Babrowicz
keywords: Catheter; Fluoroscopy; Obesity; Subclavian; Ultrasound