The central venous catheter (CVC) has been in clinical use for more than half a century. It was initially used for total parenteral nutrition. However, its indication gradually expanded to chemotherapy, intensive care, anesthesia, and other areas. As the application of CVCs increased, complications also increased. Nevertheless, some guidelines for CVC insertion have been implemented, and clinicians worldwide are working hard to prevent complications during CVC insertion. However, the safety of CVC removal has not been given adequate attention. Because of a few reports on complications, such as air embolism and airway obstruction, clinicians are recognizing the potential risks associated with CVC. However, a few medical staff recognize the possibility of associated neurological complications. We herein report a case of a patient who underwent anesthesia for the removal of a CVC, which was inadvertently inserted in the epidural space. The catheter was used to monitor central venous pressure and as a route for medicine administration before the recognition of its abnormal position. Although the distal luminal wave pattern was similar to that of a normal central venous line, heparin did not exert its expected effect after administration from the distal lumen. Conversely, appropriate blood pressure responses were observed following the administration of inotropic agents from the proximal lumen. Objective neurological monitoring was required for removal because of the involvement of general anesthesia. After general anesthesia induction, the surrounding tissue of the CVC was dissected toward the deep layer of the neck. Arterial bleeding occurred immediately after removal. After 33 minutes, the motor-evoked potential (MEP) waves deteriorated. Angiography showed bleeding from the left vertebral artery into the spinal canal. Consequently, emergency coil embolization of the left vertebral artery was performed, followed by emergency laminectomy to decompress the spinal canal. All procedures were completed, and the MEP waves completely recovered. The postoperative course was uneventful, and the patient was discharged after 17 days. In this case report, we discuss the appropriate removal steps for a CVC inadvertently placed in the epidural space.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560403 | PMC |
http://dx.doi.org/10.7759/cureus.71435 | DOI Listing |
JA Clin Rep
December 2024
Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
Background: The standard of care for placement of a central venous catheter (CVC) includes a real-time ultrasound (US)-guided technique. We describe a rare case in which the guidewire penetrated the posterior wall of the vessel, forming a knot, which precluded simple removal. This occurred despite the procedure being performed under real-time US guidance.
View Article and Find Full Text PDFJ Vasc Access
December 2024
St. Joseph's Regional Medical Center, Paterson, NJ, USA.
Background: The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.
View Article and Find Full Text PDFJ Cardiothorac Surg
December 2024
Department of Cardiothoracic Surgery, Suining Central Hospital, No. 127, Desheng Road, Chuanshan District, Suining, 629000, China.
Background: The conventional arteriovenous approach closure of patent ductus arteriosus (PDA) may be associated with more complications, especially in young infants. The objective is to explore the feasibility and clinical efficacy of interventional closure of PDA through a single venous approach under echocardiography without angiography.
Methods: 112 patients (32 males and 80 females) with PDA closed by different methods in Suining Central Hospital were enrolled, including 60 cases (Group 1) with a single venous approach under echocardiography without angiography and 52 cases (Group 2) with the conventional arteriovenous approach.
Crit Care
December 2024
Department of Critical Care Medicine, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China.
Background: Perioperative airway management and oxygenation maintenance during central airway obstruction (CAO) treatment pose great challenges. While veno-venous extracorporeal membrane oxygenation (V-V ECMO) shows promise as a bridge therapy, optimal implementation and management strategies remain lacking. We present our experience with V-V ECMO in CAO management from a high-volume center.
View Article and Find Full Text PDFJ Physiol Sci
December 2024
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Fenestration has been reported to enhance Fontan hemodynamics in several cases of Fontan circulation. However, the indication criteria for fenestration remain under discussion. To assess the effectiveness of fenestration in Fontan circulation, we conducted a theoretical analysis using a computational model of the fenestrated Fontan circulation.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!