Perforation of the Great Vessels During Central Venous Line Placement

Abstract

Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.

Guidelines for the prevention of intravascular catheter-related infections

“…Selection and replacement of intravascular catheters A. Select the catheter, insertion technique, and inser-tion site with the lowest risk for complications (infectious and noninfectious) for the anticipated type and duration of IV therapy [22,55,59,[216][217][218]. Category IA B.…”

“…Selection of catheter insertion site A. Weigh the risk and benefits of placing a device at a recommended site to reduce infectious complications against the risk for mechanical complications (e.g., pneumothorax, subclavian artery puncture, subclavian vein laceration, subclavian vein stenosis, hemothorax, thrombosis, air embolism, and catheter misplacement) [22,55,59,218]. Category IA B.…”

Overdose of propofol in a child

“…Our attempts to limit the risk of cardiac erosion by ensuring placement of the catheter outside the right atrium may well be increasing the incidence of catheter-related thrombosis [3,4]. Placing the catheter tip within the right atrium may reduce the incidence of thrombosis.…”

“…................................................................................................................................................................................................................ Second, experience of propofol in children, particularly those below 2-3 years old, is limited [2] and the exact dose regimen is still not clear. In these circumstances it is better to use the lowest titrated dose or a CNS monitor such as the Bispectral index [3]. A low BIS could have alerted the authors of the ongoing adverse event related to the propofol overdose.…”

“…Equipment modifications that lead to difficulty in insertion may increase complication and failure rate, particularly in paediatric patients [2,3]. We notified the Medicines and Healthcare products Regulatory Agency and the manufacturer, who confirmed that a change had been made in the dilator for these packs and subsequently withdrew the packs from our hospital.…”