Central line placement case-study

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Sethi, N.K., Torgovnick, J., Sethi, P.K. and Arsura, E. (2008) Ipsilateral hemispheric ischaemic hypoxic changes during central line placement: a video-electroencephalogram correlate. Emergency Medicine Journal. 25(12), p.831.

Abstract:

When venous access is needed for intravenous fluids or antibiotics and a peripheral site is unavailable or not suitable, a central line is placed either in the neck or the groin. Complications have been reported during central line placement including (but not limited to) pneumothorax, haemothorax, arrhythmias, air embolism and introduction of infection. The case history is reported of a patient who developed ipsilateral hemispheric ischaemic hypoxic changes during central line placement. This was represented on the surface electroencephalogram by ipsilateral hemispheric voltage attenuation.

Video-electroencephalogram (EEG) recording was requested on a 65-year-old man with septicaemia and renal failure for evaluation of episodes of altered awareness. During review of the overnight record, note was made of a sudden change in the EEG background with abrupt appearance of left hemispheric voltage attenuation (figs 1–3 in online supplement). This lasted for about 30 s before a return to baseline (fig 4 in online supplement). Upon review of the video record it was noted that a central line had been inserted in the left neck with pressure being applied at the base of the neck. Abrupt onset of left hemispheric voltage attenuation occurred and the patient was noted to have violent jerks of his arms and legs (see online video). With removal of the pressure at the base of neck, the EEG returned to baseline.

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