Kinking of Transfemoral Central Venous Catheter in an Infant: A Case Report

Abstract

Submit Manuscript | http://medcraveonline.com procedure for extrahepatic biliary atresia. Because of major nature of the procedure and difficult peripheral cannulation CVC through femoral route was planned. A 4.5 F, 6 cm triple lumen central venous catheter was inserted through the right femoral vein using the Seldinger´s technique in the first attempt without difficulty. A good back flow was confirmed and the catheter was secured and taped. During the surgery there was difficulty in aspiration of blood although fluid and blood infusions were smooth. Postoperatively chest X-ray was done which revealed kinking of the catheter in the right femoral vein. The fluid infusion was terminated and catheter was removed (Figure 1). DiscussionThe main purpose of CVC in infants are major surgical procedure, difficult peripheral cannulation, administration of drugs, fluids, total parentral nutrition, blood and central venous pressure monitoring. The common sites of catheter insertion in infants are subclavian vein, internal jugular vein, femoral vein, umbilical vein or external jugular vein. The subclavian venous cannulation has complication rate of approximately 4% [1] which includes malpositioned catheter into the ipsilateral IJV or contralateral SCV, pneumothorax, haemothorax and air embolism. Cardiac temponade leading to death has also been reported as a major complication with SCV, IJV or umbilical vein cannulation. Weil et al. [2] found that the catheter tip in right atrium is associated with increased risk of cardiac tamponade. Kayashima K et al. [3] evaluated the mechanical complications during paediatric CVC from 1994 to 2013 and found that most of these complications are associated with SCV, IJV, umbilical vein cannulation. In an another study done by Jha M et al. [4] showed more complication rate with SCV cannulation as compared to FV cannulation in terms of more arterial puncture, hematoma and pneumothorax. Advantages of femoral cannulation includes large diameter of the vein, convenient access and distant to the cardiac and pulmonary structures. Accident arterial puncture can be easily managed by applying pressure. So in our case, we selected femoral route for central venous cannulation, but it also has inherent complications.Malposition of femoral venous catheter into ascending lumbar vein was detected by Carrion et al. [5] which was then repositioned using ultrasonographic guidance. Paravertebral and intraspinal malposition resulting in quardiplegia has been also reported in neonates [6]. Therefore catheters in the ascending vein or vertebral plexus should be removed immediately. First warning signs of catheter malposition is absent blood on aspiration. Others are catheter present over vertebral column on x-ray and resistance to guide wire insertion. In our case we could not aspirate blood and were also unable to reinsert the guidewire. These malpositioned catheters can be identified by ultrasound, X-ray, linogram (contrast enhanced study) and fluroscopic screening. In our case X-ray abdomen revealed kinking o...