Central Venous Catheter Misplaced in the Innominate Vein after Penetrating the Left Subclavian Vein in a Neonate - A Case Report -

Abstract

In the pédiatrie ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and sei-ves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.In the pédiatrie ICU and operating room, the placement of a central venous catheter (CVC) is essential in order to obtain accurate hemodynamic information, and for the administration of vasoactive drugs and fluids. [1,2] Additionally, current therapeutic techniques for the treatment of leukemia, the use of hemodialysis, and the need for long-term parenteral nutrition or antibiotic therapy require large-sized vessels with a high blood flow. Predictable complications of central vein catheterization include arterial puncture, pneumothorax, air embolism, arrhythmia, malpositioning of the catheter and cardiac tamponade. Catheter malposition results in not only faulty central venous pressure measurement but also significant complications such as thrombosis, arrhythmia, cardiac perforation, and cardiac tamponade.