Transient neurological deficit due to a misplacement of central venous catheter despite ultrasound guidance and ultrasound assistance.
Central venous catheters (CVC) are frequently used in intensive care units (ICU), with a low incidence of complications, most of them being of mechanical origin and occurring during the insertion of the catheter. To avoid such complications, "ultrasound guidance" and "ultrasound assistance" are recommended. Nevertheless, even with trained and experienced physicians, mechanical complications of IJV access such as carotid punctures are still reported. We report the case of a 75-year-old woman, admitted into the ICU for CVC insertion due to impossibility of peripheral venous access. About 12 hours after the procedure, the patient presented a neurological deficit. The cervical and thoracic CT scan showed a transfixing path of the catheter from the left IJV into the left common carotid artery, with distal extremity of the catheter localized in the ascending aorta. The catheter was removed, and thereafter the neurological deficit immediately and definitely disappeared. Onset of a neurological deficit after CVC insertion into the IJV, regardless the time of occurrence after the procedure, should suggest complication due to the CVC insertion, even if procedure was uneventful and chest radiography confirmed the apparent accurate position of CVC.
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Rado
R
Idialisoa
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France. Electronic address: romain.jouffroy@nck.aphp.fr.
Romain
R
Jouffroy
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Laure Castres
LC
Saint Martin
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Lionel
L
Lamhaut
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Frédéric
F
Baud
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Pascal
P
Philippe
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Pierre
P
Carli
Service d'anesthésie réanimation, SAMU, hôpital Necker-Enfants malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Benoît
B
Vivien
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003422:Critical Care; D005260:Female; D006801:Humans; D019300:Medical Errors; D009422:Nervous System Diseases / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000379:methods*
Arterial puncture; Central venous catheter; Transient neurological deficit